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Washington Beat


HCFA no more, Rx drug costs, Politics and science, Rural Medicare


Washington Beat

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Choose article section...Bureaucracy: Reform HCFA—no, we mean CMS—now! Politics & Science: Evidence-based medicine remains in waiting Congress: Rural Medicare isn't sick after all Legislation: Can we afford a prescription drug benefit for seniors?

By Michael Pretzer

Bureaucracy: Reform HCFA—no, we mean CMS—now!

The pressure is on to make the Centers for Medicare & Medicaid Services (CMS, formerly HCFA) a friendlier place for physicians and health care beneficiaries. In the House, Nancy Johnson (R-CT) and Pete Stark (D-CA) of the Ways and Means Subcommittee on Health have told the agency that "there's no reason to delay sensible changes," and listed 17 pages of changes that, presumably, make sense. In the Senate, Max Baucus (D-MT) and Chuck Grassley (R-IA) of the Committee on Finance have admonished CMS to "free providers to practice medicine." In each house, a bipartisan group of lawmakers has introduced the Medicare Education and Regulatory Fairness Act to shorten red tape at CMS.

From on high, HHS Secretary Tommy Thompson has announced the appointment of a task force to review Medicare and Medicaid rules. "Over-regulation undermines quality of care," he explains.

Politics & Science: Evidence-based medicine remains in waiting

At least four factors have kept evidence-based medicine (EBM) at bay, according to writer and consultant Michael L. Millenson:

  • The mistaken belief that science-based medical training guarantees science-based practice.

  • Beguiling technology that draws attention away from more basic EBM.

  • The public image of physicians as all-knowing and heroic.

  • The lack of identifiable victims to raise the consciousness of consumer and special-interest groups.

Nevertheless, Millenson says, four factors favor EBM:

  • It's compatible with current values and behavior.

  • It's not complex.

  • It can be tested and revised if necessary. Its results are observable.

So what's missing? "The perceived advantage of practicing EBM is not totally evident," Millenson observes.

Congress: Rural Medicare isn't sick after all

Medicare beneficiaries in rural areas aren't being shortchanged on health care, according to the Medicare Payment Advisory Commission, an independent federal body charged with reviewing Medicare policies and making recommendations to Congress. MedPAC chairman Glenn M. Hackbarth recently told the House Subcommittee on Health that contrary to popular belief, "beneficiaries' access to care, use of care, and satisfaction with care are similar in rural and urban areas."

Hackbarth added, however, that some rural beneficiaries don't "get all the care they need or the most appropriate or effective care"—and Medicare can't do much to help. The Medicare Incentive Payment program, which pays bonuses to physicians in rural areas, is "insufficient" and "inappropriately targeted," he explained. Further, Hackbarth sees little incentive for Medicare+Choice plans to expand into less populated parts of the country.

Legislation: Can we afford a prescription drug benefit for seniors?

The Congressional Budget Office recently analyzed four previously proposed plans to create a drug benefit for seniors—including one put forth by the Clinton administration and another offered by Sens. John Breaux (D-LA) and Bill Frist (R-TN). A modified version of the Breaux-Frist plan, which will probably be the prototype for legislation this year, would cost about $176 billion from 2004 to 2011, according to the CBO.

Deep down, everyone knows the estimates won't stand the test of time. Even if the CBO figures were to hold true for this decade, the rising use of drugs, coupled with baby-boomers-turned-old-folks, will have an unprecedented—and unpredictable—effect, industry observers say.

The author is the former Washington Editor of Medical Economics.


Michael Pretzer. Washington Beat. Medical Economics 2001;16:21.

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