Congressional Testimony
Sebelius Pledges to Work for Long-term
Medicare Payment Solution if Confirmed as
HHS Secretary
By James Arvantes • Washington 4/8/2009
Kansas Gov. Kathleen Sebelius told a Senate committee last week that if confirmed as secretary
of HHS, she would work to change Medicare's payment policies to increase the number of
primary care physicians. She also vowed to work with Congress to find a long-term solution to
problems associated with use of the sustainable growth rate, or SGR, formula, which is used to
determine Medicare physician payment rates.
HHS Secretary-designate Kathleen Sebelius greets Sen. Ted Kennedy, D-Mass., before a hearing
of the Senate Committee on Health, Education, Labor and Pensions. Kennedy is chair of the
committee.
Sebelius, who testified before the Senate Health, Education, Labor and Pensions, or HELP,
Committee, here on March 31 as part of her confirmation process, called for "refocusing the
payment incentives so that primary care becomes a much more lucrative profession." There are
relatively few health care professionals in preventive medicine compared with the number of
subspecialists, said Sebelius, adding "if we focus on prevention and wellness, we will not need as
many (sub)specialists."
Sebelius also called for "growing the market of primary care and family doctors" to place a
greater emphasis on prevention, wellness and early intervention. Part of this process entails
changes in the Medicare payment system and changes in graduate medical education, said
Sebelius, a former state senator and Kansas insurance commissioner.
During the HELP Committee hearing, Sen. Patty Murray, D-Wash., asked about the SGR,
assailing it as an outdated formula that relies on use of services rather than on health care
outcomes to determine payments.
"If I am confirmed as secretary, that will be a top priority -- to work with those of you in
Congress to address a long-term solution," said Sebelius. "I do believe as part of health reform,
Medicare can lead by example, and part of the leadership will require a reconfiguration of the
overall payment system. SGR is a part of it, but only a piece of it."
One of the overarching goals, said Sebelius, is to redirect payments to reward appropriate care,
quality health care outcomes and preventive care. "We have a huge opportunity with the
Medicare system to not only redesign and address the SGR itself, but also to redesign a whole
payment system that redirects care to our senior population and our disabled population," she
said.
If confirmed as HHS secretary, Sebelius will oversee CMS, the CDC, NIH, the FDA and other
agencies that account for nearly $80 billion in annual discretionary spending and hundreds of
billions more in entitlement programs.
Sebelius represents the administration's second attempt to fill the position of HHS secretary. The
administration's first choice for the position, former Sen. Thomas Daschle, D-S.D., withdrew
from consideration after it was reported he had paid $140,000 in back taxes. Although Sebelius
and her husband recently paid $7,040 in back taxes and $878 in interest, that is not expected to
derail her nomination, according to sources interviewed by AAFP News Now.