Take a quick look at his resume and most would agree that Glenn Hackbarth easily qualifies as a quintessential Washington insider. But these days it can be hard to find the chairman of the Medicare Payment Advisory Commission anywhere near Washington.
In fact, you'll have to look clear across the country to track him down at his 10-acre spread in Bend, Ore., where he spends most of his time and is more comfortable being a husband and father than an inside-the-Beltway policy wonk.
For the most part, Hackbarth and his wife, Marie, a former healthcare consultant, gave up the daily rigors of professional life five years ago when they left Boston, where both worked in the healthcare industry, and moved to the Oregon countryside to raise their family.
These days, Hackbarth figures that only about one-third of his time is spent on his duties with MedPAC, where since mid-2001 he has been overseeing a commission of 17 members from all sectors of the healthcare industry. But don't think that he's a figurehead chairman.
Though few outside of healthcare-some say even within healthcare-have heard of MedPAC or know of its workings, the commission plays a prominent role in determining how Medicare functions.
Established in 1997 by the Balanced Budget Act of 1997 that merged the Prospective Payment Assessment Commission (ProPAC) with the Physician Pay- ment Review Commission (PPRC), MedPAC is an independent commission-backed by a staff of about 30 analysts, researchers and support personnel-that forecasts trends in Medicare and helps members of Congress understand how policy decisions affect the program's operations. It makes recommendations to Congress about the program that provides health insurance to 41 million Americans and analyzes other issues concerning the federal healthcare program, such as quality of care and access to services. Before the creation of MedPAC, ProPAC advised Congress on hospital services (Medicare Part A) and the PPRC advised on physician issues (Medicare Part B).
Each year, in March and June, MedPAC issues reports to Congress. The March report addresses updates on and recommendations for Medicare payment policies. The June report focuses on a prominent Medicare issue decided by the commission. This past summer, for example, MedPAC issued a report on variation and innovation in Medicare in areas such as quality and payment.
The commissioners and the chairman are appointed to three-year terms by the U.S. comptroller general. Though the chairman is not statutorily assigned any specific duties, Hackbarth sets the agenda for the commission and is MedPAC's key spokesman.
Neutral on reform issues
Curiously enough, MedPAC has had little involvement in the current Medicare reform debate, which will decide if seniors will receive prescription drug coverage and could lead to a variety of changes that will affect provider reimbursement. Under the leadership of Hackbarth's predecessor, Gail Wilensky, who served in that role from 1995 to 2001, MedPAC chose not to get involved. By the time he took over, Hackbarth says, the discourse had advanced to a point where it didn't make sense for the commission to offer an opinion.
For his part, Hackbarth declined to comment on what he thought about the drug benefit debate-which is how he approaches his role at MedPAC. His job, he says, is to look at the empirical data and offer advice, not to voice his own leanings.
"I'm here to help the commission as (a) whole find its voice and express its view, as opposed to pushing (my) particular point of view," he says. "In order to maintain MedPAC's credibility I try to avoid personal opinions on big, complicated issues."
According to Wilensky, that's the way it should be. "Any good chair recognizes they are the public face of MedPAC and recognizes that role is to push the agenda of MedPAC," says Wilensky, now a senior fellow at Millwood, Va.-based Project HOPE, an international health education foundation. She also served as administrator of HCFA, the predecessor agency to the CMS, from 1990 to 1992.
William Roper, who served from 1986 to 1989 as HCFA administrator and was Hackbarth's boss while he was a deputy administrator there, says Hackbarth's even, low-key temperament is what's needed for the head of the commission. As deputy administrator at HCFA, Hackbarth was involved in creating policies to regulate HMOs in the Medicare program and set hospital payments.
"You're giving policy advice in an area where there are continual fights about policy, and Glenn doesn't get distraught. He just stays calm and brokers compromises," says Roper, now dean of the University of North Carolina School of Public Health in Chapel Hill.
Nancy-Ann DeParle, who was head of HCFA from 1997 to 2000 and is now a MedPAC commissioner, says: "One in the job (of chairman) can't have a lot of ego ... and (Hackbarth) doesn't seem to have a lot of ego invested in the decisions we make."
Hackbarth was appointed a MedPAC commissioner in 2000, and the next year he became chairman. Wilensky wasn't reappointed to a new term as chairwoman because of concerns about her holdings in eight healthcare companies. After Hackbarth was appointed a commissioner, he continued to be active in consulting physician groups on HMO issues but chose to stop soon thereafter to avoid any appearance of a conflict of interest. That decision was supported by David Walker, the U.S. comptroller general who named Hackbarth to the chairman's post.
"I chose Hackbarth because not only was he qualified, but he was viewed as a consensus-builder by the other members of MedPAC," Walker says.
Hackbarth describes most of the sessions with the other commissioners as respectful and collegial, though he says there are times when differences of opinions become heated. In January, he recommended gradually phasing out the extra payments made to teaching hospitals to offset the higher costs that they incur, saying the hospitals have been receiving $2.6 billion each year in additional funding but have shed little light on how the money is being spent.
The other commissioners, however, were concerned that eliminating the extra funds would compromise not only the care of patients but also the education of future doctors. In the end Hackbarth relented. "So we're concerned now about adding increased accountability of how the money is used," he says.
A long career in healthcare
For Hackbarth, who turned 52 in September, becoming commission chairman was the culmination of a long career in healthcare. But healthcare wasn't a lifelong ambition. Like many little boys, he grew up dreaming about a career as an athlete. And he says healthcare never even made it onto his radar screen.
Even by his early college years healthcare wasn't much of a consideration. After entering Pennsylvania State University for his undergraduate degree, Hackbarth became interested in politics and government-majoring in political science. He didn't get into the healthcare arena until after graduation from Duke University School of Law when he went to work for the American Enterprise Institute, a Washington-based conservative think tank, as a research associate in healthcare issues.
Interspersed with his stints at HCFA and HHS' Office of Planning and Evaluation, where he helped develop Medicare policy, Hackbarth served as president of Harvard Vanguard Medical Associates, a Boston multispecialty medical group. He oversaw the separation of the medical group from Harvard Community Health Plan, where he previously had been a senior vice president. Harvard Vanguard and Harvard Community had been aligned, but after Harvard Community merged with Pilgrim Health Care, forming Harvard Pilgrim Health Care, the medical group chose to separate from the health plan.
In 1998, after taking a trip through the West Coast, Hackbarth says he and his wife came to the realization that it was time to concentrate on raising their family and decided to give up their full-time jobs and move west.
Most of Hackbarth's time is spent driving his children to soccer and ski practice or to rodeos where his daughter, Alexandra, competes for her school, and tending to two horses and two Alaskan huskies. He also accepts some speaking engagements at healthcare conferences but says he limits his appearances.
Hackbarth says he travels to Washington about once a month, typically for a week or so, for regular MedPAC meetings or to meet with lawmakers, leaving day-to-day details to Mark Miller, MedPAC's executive director.
Being located across the country from Washington apparently has not been a detriment to his job or the commission. Though he may not be at MedPAC headquarters, Hackbarth says he's involved in MedPAC-related work every day.
Miller says he and Hackbarth communicate daily and that Hackbarth stays in the loop despite being physically removed from MedPAC's offices. "Glenn is a very strong, proactive chair. Whether he lives in Washington or the West Coast doesn't change that," Miller says.
David Durenberger, a MedPAC commissioner and the former senior U.S. senator from Minnesota from 1978 to 1995, says MedPAC gets inundated with self-serving information from lobbyists in the healthcare industry and requests for meetings. Living in Oregon in large part shields Hackbarth from that, says Durenberger, now chairman of the National Institute of Health Policy at the University of St. Thomas in Minneapolis.
When Hackbarth travels to Washington, it's often to speak with members of Congress. Given the complexity of Medicare, he says he recognizes Congress doesn't have an easy task trying to make sense of sometimes mind-numbing minutiae, a job made even more difficult by lobbyists.
The purpose of his job, and those of the entire MedPAC staff, he says, is to help lawmakers weed out fact from fiction in as simple and uncluttered a way as possible. "It's complicated stuff and takes way more time than the average congressman can spend on it," he says.
Hackbarth was reappointed in May to a second three-year term as MedPAC chairman. Typically, the commissioners and the panel's chair leave after their second term. Hackbarth has no plans for what he will do after finishing his commission duties, but he doesn't consider resuming a life in Washington an option.
"I enjoy it when I go back (to Washington)," he says. "But I usually go for a week and by then I'm ready to get on a plane, come home and go to bed."
Birthplace: Elmira, N.Y.
Family status: Wife, Marie; children: Andy, 13 and Alexandra, 16
Education: Bachelor's degree in political science, Pennsylvania State University, State College, Pa., 1973; master of arts degree in public policy and law degree, Duke University, Durham, N.C., 1973-1977
Previous jobs: Research associate, American Enterprise Institute, Washington, 1977-1979; research associate, Duke University School of Law, Durham, N.C., 1979-1981; Office of Planning and Evaluation, HHS, Washington, 1981-1984; Washington counsel, Intermountain Health Care, Washington, 1984-1986; deputy administrator, HCFA, Washington, 1986-1988; senior vice president, Harvard Community Health Plan, Boston, 1988-1995; president, Harvard Vanguard Medical Associates, Boston, 1996-1998; independent consultant, 1998-present