CMS stifles primary care. Washington sleeps.

Brian Klepper and Paul Fischer take aim at the approach used by CMS to set rates for the various medical specialties. Thanks to ePatient Dave for leading me to this and for reminding me that this was a topic I covered last October, based on a report in the Wall Street Journal and insights from several of the doctors at my hospital. In short, a secret, unaccountable panel makes recommendations to CMS that favor proceduralists over cognitive specialists. These recommendations then get translated into the actual rates paid to the different types of doctors.

In their article on the Health Affairs Blog, Klepper and Fischer note:

We have focused on rallying the primary care and business communities to pressure CMS for change, and are contemplating a legal challenge. But the obvious question is why these steps are necessary. Why doesn’t CMS address the problem directly? Why does it continue to nurture the relationship?

So, while CMS is busy trying to revise impractical ACO regulations and also persists in avoiding pressure on its delegated agency, The Joint Commission, to make public the best practices of hospitals that pay funds to be accredited, it fails to act on this poor process and the resultant skewing of rates. And not a word about this from elsewhere in the Administration or the Congressional leadership.