Roy M. Poses, MD
Posted 12/09/11 on Health Care Renewal
An article from the Project on Government Oversight (POGO) reveals a new aspect of the growing coziness between the US government and big corporations with obvious relevance to health care.
CMS’ Coziness with Leaders of the “Capital Markets”
Here is the introduction and the example most relevant to health care:
Nearly a dozen senior staff at the Centers for Medicare and Medicaid Services (CMS), the giant agency that administers hundreds of billions in federal health care dollars, had been called to a meeting. After a discussion with five Wall Street professionals that lasted nearly two hours, one senior CMS analyst filed an ethics complaint that later went to the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS).
His beef: that a handful of deep-pocketed investors had won a private hearing to probe whether the agency would allow Medicare reimbursement for specific medical devices manufactured by companies in which they already held a stake or might put new money. The market for one device, already approved for Medicare, was rapidly heading toward $1 billion annually; the agency’s impending decision to reimburse competing devices could have major market impact, a shift potentially worth hundreds of millions of dollars.
‘This meeting forced agency staff to redirect their attention toward a select group from Wall Street, when neither competing investors nor patient-oriented stakeholders were present,’ the whistleblower told the Project On Government Oversight (POGO). ‘They got to probe us for hours in private about what we planned to do and how we approached procedures for reimbursing medical devices, the mechanics and psychology of CMS decision-making, in general and with respect to these specific devices.’
The meeting was set up by a former CMS employee working for the Marwood Group, an asset manager that counsels big health-care industry investors, the whistleblower says. The firm’s president is Edward ‘Ted’ Kennedy Jr., son of the late Massachusetts senator and a major supporter of President Obama’s health care reforms, and includes Kennedy cousins Robert F. Kennedy, Jr. and Stephen E. Smith, Jr., as senior advisors. The firm’s website highlights its staff recruitment among Congressional aides, the Executive Office of the President and CMS. One CMS veteran who joined Marwood after the 2009 meeting with Wall Streeters is Barry Straub, the agency’s former Chief Medical Officer, who is also an expert on Medicare reimbursement, the website says. A company spokesman had no comment.
A supervisor at CMS’s Coverage Advisory Group, which decides which services the agency will pay for, also helped organize the session with investors. The whistleblower says he was told by a supervisor that such get-togethers are ‘a routine practice at CMS.’ At the time, in 2009, CMS’s top administrator had an aide with the title, ‘capital markets advisor,’ tasked with tracking investment community activity in Washington and elsewhere.
At the investor meeting, Wall Streeters asked a range of questions ‘about confidential CMS information.’ The whistle blower says he does not believe they received illegal disclosures, though they peppered CMS analysts with queries about the agency’s decision-making process and other sensitive matters which, if answered, could have violated the law or related regulations that bar the sharing of internal deliberations and decisions.
The whistleblower first filed his complaint in April 2009. He was terminated in 2011 for being disloyal to the agency mission after he made a series of internal protests, including the objection to what he calls a pattern and practice of unfettered access to CMS staff by Wall Street investors. He says he is currently fighting his dismissal through all available legal and administrative channels.
Implications and Summary
As the POGO article put it,
CMS does have a set of ‘Open Door’ policies and affords a variety of avenues for public access. The disclosure of payments to physicians and teaching hospitals by pharmaceutical companies and other interests are required under President Obama’s health reform. In practice, however, the public, not to mention competing investors and stakeholders, rarely get the kind of information and insight available in meetings like the whistleblower described.
A balance is necessary between the danger of too much insider access, and imposing excessive limitations. Indeed, the biggest problem with special access for Wall Street insiders is not just that they seem to get meetings and acquire information that may be privileged and non-public, but that others, including other investors, do not get a crack at the same material.
The activities above have all the usual elements of excess corporate – government coziness. These include enhanced access for corporate leaders beyond what any ordinary members of the public might achieve; the revolving door between government service and corporate leadership; the participation of well-connected inside the beltway types, etc, etc.
It also includes the apparent formalization of representation of corporate interests, e.g., the “Capital Markets Advisor,” with no parallel formalization of the public’s or patients’ interests. Even more worrisome is that an effort to make this all less anechoicresulted in alleged intimidation of a whistle-blower.
So, let’s see, CMS, the Center for Medicare and Medicaid Services, the US Department of Health and Human Services (DHHS) branch which controls the Medicare and Medicaid programs, the government run single-payer programs for the elderly, the disabled, and the poor, does not seem to be able to afford to figure out in-house how to pay physicians for specific services. Instead, it has effectively farmed out this task to a private committee, the American Medical Association’s RBRVS Update Committee (RUC). As we have discussed many times, this obscure and secretive committee likely had a major role in structuring the financial incentives that favor procedures and disfavor primary care. leading to excess costs, declining access, and degrading quality. However, CMS can afford to have a “Capital Markets Adviser” and to use up staff time briefing wealthy investors and hedge fund types. What is wrong with this picture?
In my humble opinion, government health care agencies ought to put the public’s and patient’s health first. They should not give special consideration to the rich, the powerful, the well-connected, whom some now call the one percent. Yet in the US we seem to have an increasingly corporatist state in which government and the plutocrats work together for their mutual interests, regulatory capture writ large.
We need to restore government, and our health care agencies to being of the people, by the people, and for the people. Obviously, true health care reform would start with the government and its officials putting patients’ and the public’s health first, way ahead of the financial comfort of corporate leaders.
Roy Poses MD is a Clinical Associate Professor of Medicine in Brown University’s Department of Biology & Medicine. He writes at Health Care Renewal.