Retiring CMS Head Gets High Marks

Mark McClellan, M.D., Ph.D., is leaving his post as administrator of the federal Centers for Medicare and Medicaid Services (CMS), citing a desire to spend more time with his family.

“This was a hard decision, because this is the most exciting and rewarding place that anyone could ever work,” McClellan wrote in an e-mail sent to CMS staff and reporters. “But I've been in government service for much longer than my family and I had ever expected or prepared for, and after almost six years in this administration plus service in the previous administration as well, I'm looking forward to more dinners at home with [my wife] Steph and our daughters.”

Attorney Leslie Norwalk, CMS deputy administrator, has been named acting head of the agency effective October 15.

As CMS administrator, McClellan oversaw Medicaid and Medicare, which together provide health benefits for about 90 million U.S. residents and manages a federal budget of about $700 billion. One of his primary responsibilities during his tenure at CMS was administering the implementation of the Medicare Part D prescription drug benefit, which began in January.

“Dr. McClellan did a yeoman's job during a very difficult period—when CMS was responsible for the implementation of Medicare Part D,” said Eugene Cassel, J.D., director of APA's Division of Advocacy.“ We hope the next director will be as engaged.”

“The Part D program is a historical landmark for the Medicare program,” commented Irvin Muszynski, J.D., director of APA's Office of Healthcare Systems and Financing. “Both before and after the program's launch this past January, Dr. McClellan was accessible and thoughtful and provided leadership on key problems that we identified as having an adverse impact on people with mental illness.

“Another CMS issue that is important to psychiatry is the Medicare physician fee schedule [see Original article: page 17]. Effective January 1, overall Medicare reimbursement for physician services will drop by 5.1 percent unless Congress takes action. It is critical that Dr. McClellan weigh in to support a reversal of the scheduled cut and urge a positive payment update instead. As a physician, he understands the need to reimburse physicians appropriately for their services so that they can continue to provide quality care to beneficiaries.”

McClellan was sworn in as CMS administrator in March 2004, after serving for two years as commissioner of the Food and Drug Administration. Prior to that appointment, he had been a member of the White House Council of Economic Advisers and a senior health policy aide to President George W. Bush.

“We've worked with partners to get 90 percent of people with Medicare into drug coverage, and we've implemented the biggest transition in drug coverage ever in this country,” McClellan wrote in his farewell e-mail.“ We've found and fixed startup problems, we are delivering coverage at a cost at least 25 percent less than had been expected, and we are seeing beneficiary satisfaction rates of over 80 percent. For 2007, the benefit costs are going down further, and many drug plans will have lower premiums and options for enhanced coverage as well.”

McClellan also cited work undertaken during his administration to reorient the Medicare program toward preventive services.

“In Medicare, with drug coverage, new preventive coverage, new services to provide support for people with chronic diseases, and better coordinated care options than ever before, we are shifting the focus to prevention and care coordination,” he wrote. “One of the most important parts of this transformation involves the original Medicare program, which now has more support for prevention and quality care than ever....

“And we have also taken critical steps to transform Medicaid, as we implement the most important reform legislation in the program's history,” he wrote. “[M]ore people with a disability have control over how they get long-term-care services than ever before, and more states are implementing coordinated care for dually eligible beneficiaries than ever before. This has all happened as we have slowed the rate of Medicaid spending growth, from the double digits five years ago to around 5 percent this past year.” ▪