Reform Update: Ginsburg to leave Center for Studying Health System Change

Paul Ginsburg, the Harvard-trained economist and health policy expert who founded the Center for Studying Health System Change in 1995, will step down as the organization's president at the end of the year to pursue consulting work and other activities.

His departure will happen just before the Center for Studying Health System Change—which was established to provide policymakers and private-sector stakeholders about changes in healthcare finance and delivery—will integrate with its sister company, Mathematica Policy Research, on Jan. 1.

Ginsburg, who has been named to Modern Healthcare's 100 Most Influential People in Healthcare eight times, said the catalyst for his leaving is the end of a five-year funding contract from the National Institute for Health Care Reform, which expires at the end of the year.

“Without that, there was not much reason for me to stay,” he said. “The rest of the research staff will stay as researchers and Mathematica employees.”

Ginsburg, 68, said in an interview Monday that his recent work brought him back to his roots in healthcare policy analysis as a deputy assistant director of the non-partisan Congressional Budget Office and the founding executive director of the Physician Payment Review Commission, now the Medicare Payment Advisory Commission. Both of those posts, as well as his experience at the helm of the Center for Studying Health System Change, have prepared Ginsburg well for a topic he says will continue to be a huge issue in healthcare.

“I believe provider payment reform will be very important,” Ginsburg said. “ACOs, global payments, bundled payments—I see there is such strong interest to get away from the very fragmented payment approaches we've used to motivate the delivery system to coordinate its work and manage chronic disease better,” he added. “I think that is going to be the most important thing.”

Meanwhile, he said there is a connection between the evolution of insurance that will be influenced by the Patient Protection and Affordable Care Act and the speed with which provider payment reforms are processed. He plans to continue examining all of these areas in the next phase of his career.

Ginsburg said word began to spread last month about his departure after he told colleagues of his plans. Those plans will include consulting work and possibly serving on various boards. He said he's also been contacted about possible positions. “My consulting will focus on helping people understand developments in healthcare markets,” Ginsburg said, “and working with people to analyze different policy approaches.”

In an e-mail to several of his contacts on Sunday, Ginsburg wrote that the Center for Studying Health System Change had received “generous core support” from the Robert Wood Johnson Foundation for many years, and, more recently, funding from the National Institute for Health Care Reform that gave his organization the opportunity to pursue large-scale, high-quality research projects. Without that funding, he noted in the e-mail, the Center for Studying Health System Change can no longer continue its mission.

As he completes his tenure, Ginsburg struck a reflective note about the Center's work and accomplishments for nearly 19 years, saying he received about 100 e-mail messages in the last two days from people who told him how valuable that work has been in the healthcare community.

“I think the main thing is to celebrate the accomplishments,” he said. “And to the degree I have a lot of wisdom and experience in healthcare and policy to bring, I'm hoping to continue to bring that,” only in a different way, he added.

Physician groups gave the CMS a mixed reaction on its proposed 2014 Medicare fee schedule. While medical associations generally applauded a plan to, starting in 2015, begin paying primary-care physicians for care-management tasks that don't involve face-to-face contact, they also found plenty to object to in the proposed fee schedule such as the continued complexity and duplication of multiple data-reporting programs and a proposed plan that would result in decreased payment for some office-based procedures and services.

The California Medical Association, in its 18-page letter to CMS Administrator Marilyn Tavenner (PDF), objected to a proposal which would group physician work together with tasks carried about nonphysician clinical staff for the purpose of calculating the CMS geographic practice cost index, or GPCI. While a recent IOM report noted that geographic healthcare costs are driven mostly by post-acute care services, the CMA based its objections on how the move would serve to “further devalue physician work.”

Though it may appear to be an esoteric point, the CMA argues that the move would reduce payments to California physicians by $46 million. This reduction would come on top of a 10% cut in Medicaid payments the state is planning to implement.

The American Medical Group Association is objecting to the CMS' proposed methodology for establishing quality performance benchmarks in its Medicare shared-savings program. The CMS plan calls for establishing benchmarks using information from accountable care organization performance data obtained in previous years or data from Medicare fee-for-service or Medicare Advantage programs. If these sources are inadequate, the CMS proposed using a “national flat percentage.” In its comment letter (PDF) on the proposed 2014 physician fee schedule, the AMGA argues that the use of such an “arbitrary” figure could harm high-performing ACOs and discourage future participation in the program.

This concern was echoed in the letter sent by the Premier healthcare alliance (PDF). “Premier believes that using flat percentage benchmarks could result in most ACOs performing at or below the arbitrarily set benchmark,” Blair Childs, Premier health alliance senior vice president of public affairs, wrote in the letter to Tavenner. “Moreover, for some measures, even the best performers would be unable to attain the threshold if it were set at 100% compliance.”

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