As CMS Administrator, Mark McClellan will probably be remembered -- positively or negatively, depending on your perspective -- for shepherding Medicare's Part D drug benefit through initial implementation. But beyond such individual accomplishments (or setbacks), the McClellan legacy will likely also be flavored by an important thematic: an inclination to act, sometimes for good, sometimes for ill, but, in the end, a combatant always in the arena.
McClellan, who announced his resignation earlier today, appears in retrospect not so different from another public official who seemed to relish his position not for what it was, but for what it allowed him to do. You could accuse David Kessler of many things when he was FDA Commissioner, but one charge to which he remained invulnerable was that of stand-pat-ism. Same with McClellan. He seemed to perfect the art of being everywhere, always with an opinion, always ready to defend it through resort to close analysis and facts.
He arrived on the job well-prepared -- physician; health economist who had published significant studies on the value of medical technology; an FDA Commissioner like Kessler; White House aide; member of a politically accomplished Texas clan intertwined with the Bushes. It was a strong platform, and McClellan made the most of it. You could almost sense in him a will to overcome the inertia of officialdom.
Example: Medicare chiefs had been talking since before there was a CMS, since before there was even a HCFA, about addressing coverage of new medical technology, but McClellan actually did something about it. His policy on Coverage with Evidence Development, or "CED" (see earlier post, "CED Strains Nomenclature, Vocabulary") will have its fans and its detractors. But give the man his due. He did the tough blocking and tackling needed to craft a dramatically new approach -- to turn abstract talk about "conditional coverage" into an actual on-the-ground, in-your-face policy.
Example: McClellan wasn't hesitant to order up a deftly administered dose of Medicare demonstration authority if the situation seemed to warrant it. When physicians were set to take a hit on Part B drug payments, CMS instituted a demonstration that reimbursed for certain of their chemotherapy treatments, provided they filed data on patient outcomes (thus killing another bird with the same policy stone). To say that not all these demos produced pristine policy results -- the OIG recently criticized the chemo demo, for example -- misses the point. Like a dog that talks, though sometimes imperfectly, the fact that some of these demos could be done at all is what's amazing. Indeed, they stand as the mark of a resourceful leader intent on moving his agenda.
As so you can love Mark McClellan . . . or not. But whatever your view, his record of impatient forward motion is one we're unlikely to soon see again at CMS.
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