image description

Former Congressman Dr. Phil Gingrey provides public policy and government relations counsel to clients on a variety of issues. Here at Phil on the Hill, Phil draws upon his long career in public service to provide perspective and context on policy topics such as health care, the federal budget, annual appropriations, regulatory reform, and life sciences.



MedPAC Rising

Wednesday, December 20, 2017

Integrating a law as complex as the Affordable Care Act (ACA) into the already complex American health care system has predictably proved to be a great challenge. Seven years after its passage, policymakers are still hammering out precisely how to implement some parts of the ACA. Even if Republicans fail to repeal or significantly modify the ACA, we should expect reorganization of health care in this country to go on for years.

As lawmakers grapple with one budgetary and healthcare dilemma after another, they are coming to see federal advisory commissions as nonpartisan centers of expertise. As a result, these commissions, long thought of as playpens for policy wonks, are becoming influential players in health care.

The most influential is the Medicare Payment Advisory Center (MedPAC). Created by the Balanced Budget Act of 1997, MedPAC is charged with providing expertise in health care payment and delivery. In its twice-a-year reports to Congress, MedPAC’s analysis and advice is enjoying growing sway on the Hill.

Mark Miller, the longstanding executive director of this independent body, stepped down in November, MedPAC’s first leadership change in 15 years. In a show of continuity, he was replaced by his deputy James Matthews. MedPAC today is weighing in on many important issues, including a recommendation to scrap the new Medicare physician Merit-based Incentive Payment (MIPS) system which was created to replace the flawed sustainable growth rare formula, which previously determined doctor reimbursement. Many in Congress rely on MedPAC to advise them on a thousand such details as American health care struggles to transition from fee-for-service to value-based care. The Department of Health and Human Services and the Centers for Medicare and Medicaid Services also use MedPAC’s reports and recommendations as vital insight and input in preparing and evaluating policy.

In these chaotic political times, it is important to remember the influence of organizations like MedPAC. With acronyms abounding, it can be hard to keep the precise purpose and function of these commissions straight. One need to look no further than the Russian nesting doll of acronyms found in the Medicare and CHIP Payment and Access Commission(MACPAC), created by the Medicare Access and CHIP Reauthorization Act.

Much of what these commissions recommend ends up as regulatory policy and law. Interested parties cannot afford to ignore them. As organizations like MedPAC and MACPAC continue to grow in influence, we must be eager to participate in their public hearings, to provide useful information that helps shape their understanding of key issues, and review their reports and recommendations so we can prepare for what may likely come.