Posted on 25 June 2010.
On Wednesday, June 23, 2010, the House Energy and Commerce Subcommittee on Health held a hearingentitled “MedPAC’s June 2010 Report to Congress: Aligning Incentives in Medicare.” The hearing examined the findings and recommendations proposed in the report submitted by the Medicare Payment Advisory Commission (MedPAC) to Congress on June 15, 2010.
MedPAC Chairman Glenn Hackbarth testified that the Commission has offered 26 recommendations in two reports to Congress this year. He highlighted areas where MedPAC commissioners have reached strong consensus, such as the unsustainability of Medicare and the need to look for ways to slow the growth rate of expenditures, while improving access and quality. He stated that there needs to be consistent pressure applied to all health care services to look for ways to change relative values of payments and opportunities need to be examined that signal the type of care beneficiaries need and to reward that type of care. As an example, he highlighted the medial home concept. Additionally, Chairman Hackbarth stated that there still needs to be a robust and value-focused Medicare Advantage (MA) program because private plans have the ability to provide care in ways that traditional Medicare does not.
He explained that it is important to reform how Medicare pays for Graduate Medical Education (GME). Chairman Hackbarth stated that the Commission believes the GME system is the envy of the world, but the current system is not consistently producing physicians that the system needs to move towards a value-based health system. He noted two types of deficits in the system: 1) the mix of physicians being produced (i.e. lack of racial and ethnic diversity; and 2) content of training, evidence-based medicine, team coordination, or shared decision making is not focused on. Chairman Hackbarth stated his support for The Accreditation Council for Graduate Medical Education (ASCGME) for working on an outcomes project to refocus training on new skills and a focus on higher value health care, but urged rapid movement on implementing value-based standards.
Republican Members of the Committee largely used the hearing as a platform to air its grievances about the health reform law. Chairman Waxman described the Republican comments as “propaganda.”
The majority of members were concerned that MedPAC’s recommendation to restructure GME funds would actually take money away from teaching hospitals. Chairman Hackbarth reiterated that MedPAC was not recommending that money be taken away from hospitals, but that greater accountability be established for the funds. Specifically, MedPAC recommended that the GME funds move away from being contingent upon fee-for-service and move towards value-based care. He stated that the proposed standards for value-based GME payments would take effect in three years, which would give institutions time to conform. Chairman Hackbarth declared that Medicare could be the lever for this change.
Rep. Donna Christensen (D-VI) stated that when CMS institutes a least costly alternative (LCA) policy, providers often face a financial loss when they prescribe a product that is more expensive. She asked to the extent that Congress grants CMS explicit authority to institute LCA policies for drugs and biologics, what safeguards does MedPAC recommend so that access to medically needed therapies are appropriately observed. Chairman Hackbarth stated that least costly alternative policies and reference pricing need to be informed by the best clinical evidence and the process needs to be transparent where all interested parties have the opportunity to present information to CMS. He noted that MedPAC reported that it would be advantageous to give CMS and the Secretary of HHS more flexibility to execute these policies, but it does not mean abdication by Congress. Chairman Hackbarth noted that Congress could reserve the right override policies.
Rep. Gene Green (D-TX) inquired whether there will be a problem within the Agency for the newly created Center for Medicare and Medicaid Innovation (CMI). Chairman Hackbarth explained that the health reform law took a major step in giving the Secretary broader authority for testing new ideas in Medicare, but that in order to meet the challenges that Medicare faces, CMS will need to change the process for testing new ideas. He noted that currently innovation is painfully slow, but that the health reform law could accelerate the process. Chairman Hackbarth stated that his greatest concern is that resources will be needed to implement successful demonstrations. He also asked about self-referral and imaging services. Chairman Hackbarth stated that there is variability among the different types of imaging services, but that the combination of physician ownership, fee-for-service, and mispricing of services leads to over-utilization.