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The Obama administration is touting a provocative proposal to give a medical advisory council the power to help decide the scope of coverage that would be eligible for reimbursement under Medicare.
Administration officials say the proposed council would improve health care quality and control costs. But some health care industry groups object to the proposal, saying such a council would not be qualified to make those judgments.

This council would consist of doctors and health care experts who make recommendations based on extensive data and analysis of best health care practices, according to administration officials.

Proponents believe the approach would improve care and eliminate some wasteful spending by doctors who are now paid separately for each visit and procedure they authorize. Instead, this council could recommend, for example, a comprehensive approach to treat a patient with chronic heart condition or high cholesterol.

The administration says that by encouraging doctors to follow this type of plan, the government will save money by cutting unnecessary treatments and procedures. The council's recommendations would then go to the commission overseeing Medicare to determine the specific procedures and the actual reimbursement amount.

"It is not an exercise in just cutting reimbursement rates. In fact, in some cases, we may need higher reimbursement rates for certain aspects," President Obama said at a town hall meeting in Shaker Heights, Ohio, on Thursday.

The members of the proposed Independent Medicare Advisory Council would study different procedures and make recommendations.

Administration officials though say this council will not make decisions about what coverage a patient gets.

Still, opponents view this proposal as "big brother" dictating medical treatment.

The conservative Heritage Foundation describes the initiative as being "the equivalent of a federal health board determining how health care was rationed for all seniors."
The administration counters that doctors still will have flexibility to decide the best course of treatment depending on the individual patient but would be guided to a preferred course of action.

Doctors would have a set amount of money, or "bundle," to deal with each patient's problem instead of receiving money for each visit, test and procedure performed. Patients still would have the option of paying for more expensive procedures but would have to pick up the costs above what is deemed reimbursable by Medicare.

"Right now, if a hospital is reimbursed for the number of tests that it does, then that may not give them much of an incentive to make their system more efficient so that, once you take that first test and you've gone in the hospital, then you end up having that test sent around to everybody so you don't have to take five more tests," Obama told the Ohio audience.

Kevin Bohn and Jessica Yellin
CNN
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