Meddling with Medicare

When it comes to Medicare, every decision creates some major losers. So it's hardly surprising that they turn to Congress when they don't like the outcome of such a decision. This is surely why Reps. Anna Eshoo (D-CA) and Mike Rogers (R-MI) are trying to force Medicare to rescind new anemia drug coverage limits--someone within the drugmakers or physician lobbies got their ear.

That being said, if you're a provider, does it make sense to call your Congressman whenever CMS makes a coverage determination you don't like? Probably not. Why? Because if you don't like the way Medicare makes clinical decisions, you're going to like the way your Congressman or woman goes at it even less:

* While CMS has to at least pretend to create some clinical cover for its decisions, in the final analysis Congress can essentially make any decision it likes.

* CMS is definitely influenced by the politics of whatever presidential administration is in place, but it doesn't rely on direct donations to stay alive, so it can be more deliberative.

* Congress's incentives are slanted toward looking good to voters and donors--while increasingly, CMS is focused on tracking quality and reporting results.

I could go on and on, but you get the point I'm sure. Elected bodies like Congress are volatile, fickle and ill-suited to govern medical care. CMS has stability, data to draw on, expertise and a better-suited mandate.  

Don't get me wrong, I'm not suggesting CMS is perfect. You can argue all day over CMS's methods for making decisions, the lines it draws regarding cutoffs for payment and find (legitimate) fault with countless other policy stances. And yes, it too plays politics on many levels.  But when it comes down to it, a CMS rule-by-Congress would take away the virtues the agency does possess. 

So before you ask your trade group to lobby Congress regarding the latest Medicare debacle, you may want to envision a future in which Congress slaps CMS around habitually on day-to-day-operational and clinical matters. Believe me, it'll be worse than what you're facing today.- Anne