Buried deep in the never-quite-dead Republican budget plan, with thousands of spending constraints great and small, is a provision to combine the two major Medicare congressional advisory panels, the Physician Payment Review Commission, which handles primarily Medicare Part B matters, and the Prospective Payment Assessment Commission, which focuses on Medicare Part A.
The idea is a good one. Congressional Republicans reasoned that with Medicare moving toward a unified capitated payment system, it makes sense to have one unified advisory committee. As a bonus, the roughly $8 million combined budget for the two groups could be shaved by a few hundred thousand dollars, getting them about 0.000005% of the way to balancing the budget in seven years.
But with the budget agreement on life support in Washington, ProPAC and the PPRC are in limbo. Because of the 1996 budget impasse, the groups have been operating under a series of temporary spending bills that have lowered their funding by about 25%, according to ProPAC Executive Director Donald Young, M.D.
ProPAC, which usually has a staff of 25 analysts, is down to 16. Some left because of the uncertainty, and their positions were not filled.
Both the PPRC and ProPAC perform useful functions, and they deserve better from Congress, which should move quickly to settle their fate.
First and foremost, ProPAC and the PPRC are about the only nonbiased, non-conclusion-for-hire, nonpartisan healthcare number-crunching shops in Washington.
ProPAC's analyses of hospital margins and costs are indispensable to healthcare policymakers and policy wonks alike, as is the PPRC's monitoring of physician utilization.
Both groups also present an annual report to Congress that includes a series of recommendations. Some of the proposals are mundane: "Congress should direct the enforcement agencies to gather and make available to the public information on antitrust problems." Others are even more mundane: HHS "should be given authority to adjust the standardized amounts if anticipated coding improvements would increase aggregate payments by more than 0.25%." A few are extremely important.
Unfortunately, Congress tends to ignore the reports except when it needs to reduce spending. In fact, Congress has enacted exactly one of the 11 hospital reimbursement recommendations ProPAC has made in 11 years.
When Congress needs to defend a cut, it turns to the PPRC or ProPAC study of its choice to say, "See, this cut is all right because (the) PPRC or ProPAC said so." The Republican balanced-budget proposal's $163 billion in Medicare savings included a PPRC-generated plan to reform the Medicare payment system for doctors and several hospital payment changes that came from ProPAC.
"We were very helpful to the Republicans, and the Republicans used us very skillfully as political cover," said Uwe Reinhardt, a Princeton University professor who served on the PPRC from 1986 to 1995.
Former ProPAC Commissioner Elliott Roberts said the "fact that many of our recommendations are not followed to the letter should not be the issue. We offered an apolitical alternative that produced a product that (Congress) could rely on."
Here is another suggestion for Congress: One mistake the Republicans made was not taking their consolidation plan a step further.
One advisory commission left out of the discussions was the Practicing Physicians Advisory Council, which was established nearly four years ago to address what were then being called the "hassle factors" of being a Medicare physician: things like submitting bills to Medicare, justifying treatments to nosy bureaucrats, and going to the bank when the Medicare and Medicaid checks come in.
Since its inception, the 15-physician group has had little input. At one point several years ago, then-Chairman Isadore Rosenfeld, M.D., threatened to quit because the topics HCFA gave the commission to review were so fluffy. Threatening to quit was the right idea. The group has had little impact and should be among those consolidated or eliminated.
Under the heading of "Don't they have anything better to do in Washington?" two lawmakers, Reps. Andrew Jacobs Jr. (D-Ind.) and Dan Burton (R-Ind.), were expected to introduce legislation last week cryptically named "The What-Really-Happened Act of 1996."
The bill would require all professional sports leagues to use instant replay to aid referees on controversial calls.
The sponsors say they were driven to introduce the plan when their home-state Indianapolis Colts lost out on a trip to the Super Bowl after referees missed a call that led to a Pittsburgh Steelers' victory.
Where is that deregulation spirit when you need it?