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Departing MedPAC Chief Pushes Focus on Outcomes over Process

By Kerry Young, CQ Roll Call

April 6, 2015 -- One of the few regrets that Glenn M. Hackbarth has about his 15-year tenure on the influential Medicare Payment Advisory Commission (MedPAC) is how it approached efforts to better align doctors' reimbursements with their performance.

"There is too much weight placed on process measures, an ever-growing list of process measures, across all provider groups," said Hackbarth, whose term as chairman of the MedPAC expires this month, in an interview with CQ HealthBeat on Monday. "There should be more of a focus on outcomes." Hackbarth is closely identified with the commission, which he first began leading as chairman in 2001 after joining as a member the previous year. "Medicare and many private payers as well have gotten on a track that is unproductive in some ways. I don’t think we are doing a good job collectively" in linking payment and performance on quality, Hackbarth said. "Many of the measures used are not very strong." 

In recent years, both the Centers for Medicare and Medicaid Services and insurance companies have sought to move toward "pay-for-performance" models, in which reimbursement policies could be structured to drive care that produces the best results for patients. As the nation’s single largest buyer of health care with annual outlays exceeding $600 billion, Medicare has great sway over the health system of the United States. "To the extent that MedPAC was an early contributor in the movement towards pay-for-performance, there are things that I would do differently if I had it to do over again," said Hackbarth, who also sees some of the administrative burden of these efforts as particularly tough on private practices. 

The Government Accountability Office likely will announce the new MedPAC chair at the end of April. Overall, Hackbarth was positive as he reviewed his years with MedPAC. MedPAC’s work is respected by members of both parties on Capitol Hill, something that Hackbarth attributes in part to the panel being able to achieve "an extraordinary degree of consensus." "We have created a culture where commissioners see their role as providing expertise and experience, not representing particular interests, whether they be providers' groups or health plans or geographic interests," he said. "It’s a culture of expertise, not representation."

Before joining the commission, Hackbarth served in various positions at the Department of Health and Human Services, including deputy administrator of the Health Care Financing Administration, now known as CMS. Hackbarth, who holds a law degree from Duke University, also was a founder of Harvard Vanguard Medical Associates, a multi-specialty group practice in Boston that serves as a major teaching affiliate of Harvard Medical School.

Hackbarth led MedPAC during years in which Congress has made dramatic changes in Medicare, including the creation of a new drug benefit in 2003.

At a meeting last week, Hackbarth noted that one of the first recommendations MedPAC made under his leadership was for "financial neutrality" with regard to insurer-run Medicare Advantage plans. These private plans have proven more costly to taxpayers than having Medicare itself manage these benefits. Congress "took a big step" in the Affordable Care Act of following MedPAC’s advice to end disparity, and moving toward the goal of having Medicare "pay the same amount for a beneficiary regardless of whether he or she was in traditional Medicare or enrolled in an [Medicare Advantage] plan," he said.

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