Medicare Governance And Provider Payment Policy

Abstract

Medicare's decision-making processes leave policies on provider payment vulnerable to "micromanagement" by Congress and the White House. If they continue as they are, they could jeopardize delivery system changes central to current health reform proposals. Ad hoc intervention in response to pressure from narrow interests can result in policies that do not serve the broader priorities of beneficiaries and taxpayers and that are unsound economically. Establishing a new Medicare policy board, as proposed by the Obama administration and Congress; transforming the Medicare agency into an independent agency or new department; and conducting analyses of congressionally proposed payment policy changes before they are voted on could further insulate payment decisions from political interference.

A focus group based study of the perspectives of the Maltese population and healthcare professionals on medication wastage

“…22 Pham et al describe the importance of segregating 'macro-level decisions' generated at a political debate level from 'micro-level decisions'. 23 This is in line with participants' suggestions around the need to redefine political will.…”

Congress as manager: oversight hearings and agency morale

“…As a recent illustration of this mechanism, scholarly research and witness testimony from administrators from the Centers for Medicare and Medicaid Services (CMS) attest that members of Congress are keen to micromanage policies governing provider payment (Pham et al 2009). The data that we compile below support these claims, indicating that there were no fewer than 377 oversight hearings from 1999 to 2013 where members of Congress expressed their views on this issue, often disagreeing with CMS policies.…”

Physicians' Opinions About Reforming Reimbursement

“…The Obama administration and health policy experts have called for the creation of an independent Medicare advisory committee. 28 However, only 1 Congressional health care reform proposal included an independent Medicare commission. 29 Without an independent arbiter, physicians and physician groups are likely to continue having complaints about the equitability of reimbursements under Medicare.…”