Todd Zwillich

WASHINGTON — A report from the Institute of Medicine has helped fuel debate on what can be done to stem the nation's increasing shortage of donated organs.

The report, written by a panel of respected experts, suggested intensified efforts to boost Americans' flagging altruistic instincts and called for research into how to improve the organ donation system.

Institute of Medicine (IOM) advisers also called for revised resuscitation standards to increase the chances that organs of brain-dead trauma victims could be preserved for transplant. They also encouraged authorities to experiment with a new cardiac standard of death, in the hopes that it could roughly double the number of available grafts culled from patients who donate after being declared brain-dead.

Such a standard could allow up to 22,000 donations per year from patients in permanent vegetative states or comas, said James F. Childress, Ph.D., a professor of medical ethics at the University of Virginia and chair of the IOM panel.

But for some ethicists, the report was more noteworthy for what it did not recommend. The IOM panel recommended against what some members of the President's Council support: Allowing the buying and selling of human organs from live donors, in the hopes that market forces move supply nearer to demand.

Some ethicists acknowledge that allowing an organ market is a radical solution, fraught with the ethical pitfalls inherent in commodifying body parts. But they see the benefit as outweighing the risk of death for the 92,400 Americans on the United Network for Organ Sharing (UNOS) waiting list. The number of Americans with end-stage renal disease is expected to double to nearly 650,000 by 2015.

Free-market advocates see it differently. Dr. Benjamin Hippen, a nephrologist at Carolinas Medical Center in Charlotte, N.C., argues that a regulated market in human organs would boost the supply of viable kidneys, while doing away with a dangerous international black market.

Dr. Hippen, an at-large member of the UNOS board, rejects the idea that a legal organ market is a necessary evil. “Mine is not an argument that the ends justify the means, mine is an argument that the means themselves to not warrant legal prohibition,” he told the bioethics council.

Meanwhile, others continue to caution that financial incentives would exploit low-income individuals desperate to sell organs out of economic need.

“We simply can't ignore the fact that the sellers are going to be the poor, predominantly. Most well-off people are not going to sell their organs as a way to buy a third car,” said Eric Cohen of the Ethics and Public Policy Center, a conservative think tank in Washington.

The President's Council on Bioethics is not expected to issue its recommendations for organ donation until the fall.

WASHINGTON — A report from the Institute of Medicine has helped fuel debate on what can be done to stem the nation's increasing shortage of donated organs.

The report, written by a panel of respected experts, suggested intensified efforts to boost Americans' flagging altruistic instincts and called for research into how to improve the organ donation system.

Institute of Medicine (IOM) advisers also called for revised resuscitation standards to increase the chances that organs of brain-dead trauma victims could be preserved for transplant. They also encouraged authorities to experiment with a new cardiac standard of death, in the hopes that it could roughly double the number of available grafts culled from patients who donate after being declared brain-dead.

Such a standard could allow up to 22,000 donations per year from patients in permanent vegetative states or comas, said James F. Childress, Ph.D., a professor of medical ethics at the University of Virginia and chair of the IOM panel.

But for some ethicists, the report was more noteworthy for what it did not recommend. The IOM panel recommended against what some members of the President's Council support: Allowing the buying and selling of human organs from live donors, in the hopes that market forces move supply nearer to demand.

Some ethicists acknowledge that allowing an organ market is a radical solution, fraught with the ethical pitfalls inherent in commodifying body parts. But they see the benefit as outweighing the risk of death for the 92,400 Americans on the United Network for Organ Sharing (UNOS) waiting list. The number of Americans with end-stage renal disease is expected to double to nearly 650,000 by 2015.

Free-market advocates see it differently. Dr. Benjamin Hippen, a nephrologist at Carolinas Medical Center in Charlotte, N.C., argues that a regulated market in human organs would boost the supply of viable kidneys, while doing away with a dangerous international black market.

Dr. Hippen, an at-large member of the UNOS board, rejects the idea that a legal organ market is a necessary evil. “Mine is not an argument that the ends justify the means, mine is an argument that the means themselves to not warrant legal prohibition,” he told the bioethics council.

Meanwhile, others continue to caution that financial incentives would exploit low-income individuals desperate to sell organs out of economic need.

“We simply can't ignore the fact that the sellers are going to be the poor, predominantly. Most well-off people are not going to sell their organs as a way to buy a third car,” said Eric Cohen of the Ethics and Public Policy Center, a conservative think tank in Washington.

The President's Council on Bioethics is not expected to issue its recommendations for organ donation until the fall.

WASHINGTON — A report from the Institute of Medicine has helped fuel debate on what can be done to stem the nation's increasing shortage of donated organs.

The report, written by a panel of respected experts, suggested intensified efforts to boost Americans' flagging altruistic instincts and called for research into how to improve the organ donation system.

Institute of Medicine (IOM) advisers also called for revised resuscitation standards to increase the chances that organs of brain-dead trauma victims could be preserved for transplant. They also encouraged authorities to experiment with a new cardiac standard of death, in the hopes that it could roughly double the number of available grafts culled from patients who donate after being declared brain-dead.

Such a standard could allow up to 22,000 donations per year from patients in permanent vegetative states or comas, said James F. Childress, Ph.D., a professor of medical ethics at the University of Virginia and chair of the IOM panel.

But for some ethicists, the report was more noteworthy for what it did not recommend. The IOM panel recommended against what some members of the President's Council support: Allowing the buying and selling of human organs from live donors, in the hopes that market forces move supply nearer to demand.

Some ethicists acknowledge that allowing an organ market is a radical solution, fraught with the ethical pitfalls inherent in commodifying body parts. But they see the benefit as outweighing the risk of death for the 92,400 Americans on the United Network for Organ Sharing (UNOS) waiting list. The number of Americans with end-stage renal disease is expected to double to nearly 650,000 by 2015.

Free-market advocates see it differently. Dr. Benjamin Hippen, a nephrologist at Carolinas Medical Center in Charlotte, N.C., argues that a regulated market in human organs would boost the supply of viable kidneys, while doing away with a dangerous international black market.

Dr. Hippen, an at-large member of the UNOS board, rejects the idea that a legal organ market is a necessary evil. “Mine is not an argument that the ends justify the means, mine is an argument that the means themselves to not warrant legal prohibition,” he told the bioethics council.

Meanwhile, others continue to caution that financial incentives would exploit low-income individuals desperate to sell organs out of economic need.

“We simply can't ignore the fact that the sellers are going to be the poor, predominantly. Most well-off people are not going to sell their organs as a way to buy a third car,” said Eric Cohen of the Ethics and Public Policy Center, a conservative think tank in Washington.

The President's Council on Bioethics is not expected to issue its recommendations for organ donation until the fall.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new—and sometimes radical—ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think its time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S. donations by up to 75%.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new—and sometimes radical—ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think its time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S. donations by up to 75%.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new—and sometimes radical—ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think its time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S. donations by up to 75%.

WASHINGTON — Frustrated researchers are calling for the gutting of what they see as faltering institutional review boards now charged with the monitoring of medical research on children.

At a meeting of the President's Council on Bioethics, scientists told council members that institutional review boards (IRBs) are overburdened with bureaucratic red tape and are increasingly hamstrung in their efforts to scrutinize pediatric research.

The bureaucracy, they said, comes from federal laws laid down in the 1970s exerting tight IRB control over research protocols. The rules were enacted to prevent lapses in the wake of several well-publicized child research ethics scandals. Instead of protecting children, the rules have weighed down IRBs and made their deliberations arbitrary, experts charged.

Dr. Robert J. Levine, professor of internal medicine at Yale University, New Haven, Conn., and others warned that IRBs now spend much of their time exercising perfunctory annual reviews of ongoing research protocols. The reviews include scrutiny of each adverse event occurring during a trial. “What I see now is a turn toward excessive bureaucracy, excessive attention to pointless detail” with IRBs, Dr. Levine said.

Dr. John Lantos, a professor of pediatrics at the University of Chicago, said that IRBs routinely struggle to enforce federal rules requiring guardians of minor subjects to give informed consent for trials posing more than a “minimal” risk to patients. Whereas the rules were meant to protect child subjects, IRB decisions on what constitutes a minimal risk have become “amateurish” and “idiosyncratic,” he said.

As a fix, Dr. Lantos urged the council to recommend a new system of what he dubbed “pediatric research courts.” The courts would operate with regional or national jurisdiction and would render decisions on whether trials meet federal standards for ethical science.

“It would do this by hearing cases, publishing rulings, establishing precedents, [and] generalizing interpretations in a way that was truly public, meaningfully accountable, and transparent,” said Dr. Lantos, adding that such a court should have “regulatory teeth.”

“It should come up with an answer the way the Supreme Court comes up with an answer,” he said.

The council is scheduled to issue recommendations on the monitoring of child research ethics, although those recommendations won't have the force of law. It will be up to Congress to enact any changes, and it is unclear whether lawmakers will back drastic changes to the IRB system.

Regardless, others who spoke before the council agreed that IRBs have lost the ability to effectively monitor pediatric research.

“We've just got ourselves stuck into a situation that is going to get worse and worse and worse,” said Dr. Paul R. McHugh, a professor of psychiatry at Johns Hopkins University, Baltimore.

WASHINGTON — Frustrated researchers are calling for the gutting of what they see as faltering institutional review boards now charged with the monitoring of medical research on children.

At a meeting of the President's Council on Bioethics, scientists told council members that institutional review boards (IRBs) are overburdened with bureaucratic red tape and are increasingly hamstrung in their efforts to scrutinize pediatric research.

The bureaucracy, they said, comes from federal laws laid down in the 1970s exerting tight IRB control over research protocols. The rules were enacted to prevent lapses in the wake of several well-publicized child research ethics scandals. Instead of protecting children, the rules have weighed down IRBs and made their deliberations arbitrary, experts charged.

Dr. Robert J. Levine, professor of internal medicine at Yale University, New Haven, Conn., and others warned that IRBs now spend much of their time exercising perfunctory annual reviews of ongoing research protocols. The reviews include scrutiny of each adverse event occurring during a trial. “What I see now is a turn toward excessive bureaucracy, excessive attention to pointless detail” with IRBs, Dr. Levine said.

Dr. John Lantos, a professor of pediatrics at the University of Chicago, said that IRBs routinely struggle to enforce federal rules requiring guardians of minor subjects to give informed consent for trials posing more than a “minimal” risk to patients. Whereas the rules were meant to protect child subjects, IRB decisions on what constitutes a minimal risk have become “amateurish” and “idiosyncratic,” he said.

As a fix, Dr. Lantos urged the council to recommend a new system of what he dubbed “pediatric research courts.” The courts would operate with regional or national jurisdiction and would render decisions on whether trials meet federal standards for ethical science.

“It would do this by hearing cases, publishing rulings, establishing precedents, [and] generalizing interpretations in a way that was truly public, meaningfully accountable, and transparent,” said Dr. Lantos, adding that such a court should have “regulatory teeth.”

“It should come up with an answer the way the Supreme Court comes up with an answer,” he said.

The council is scheduled to issue recommendations on the monitoring of child research ethics, although those recommendations won't have the force of law. It will be up to Congress to enact any changes, and it is unclear whether lawmakers will back drastic changes to the IRB system.

Regardless, others who spoke before the council agreed that IRBs have lost the ability to effectively monitor pediatric research.

“We've just got ourselves stuck into a situation that is going to get worse and worse and worse,” said Dr. Paul R. McHugh, a professor of psychiatry at Johns Hopkins University, Baltimore.

WASHINGTON — Frustrated researchers are calling for the gutting of what they see as faltering institutional review boards now charged with the monitoring of medical research on children.

At a meeting of the President's Council on Bioethics, scientists told council members that institutional review boards (IRBs) are overburdened with bureaucratic red tape and are increasingly hamstrung in their efforts to scrutinize pediatric research.

The bureaucracy, they said, comes from federal laws laid down in the 1970s exerting tight IRB control over research protocols. The rules were enacted to prevent lapses in the wake of several well-publicized child research ethics scandals. Instead of protecting children, the rules have weighed down IRBs and made their deliberations arbitrary, experts charged.

Dr. Robert J. Levine, professor of internal medicine at Yale University, New Haven, Conn., and others warned that IRBs now spend much of their time exercising perfunctory annual reviews of ongoing research protocols. The reviews include scrutiny of each adverse event occurring during a trial. “What I see now is a turn toward excessive bureaucracy, excessive attention to pointless detail” with IRBs, Dr. Levine said.

Dr. John Lantos, a professor of pediatrics at the University of Chicago, said that IRBs routinely struggle to enforce federal rules requiring guardians of minor subjects to give informed consent for trials posing more than a “minimal” risk to patients. Whereas the rules were meant to protect child subjects, IRB decisions on what constitutes a minimal risk have become “amateurish” and “idiosyncratic,” he said.

As a fix, Dr. Lantos urged the council to recommend a new system of what he dubbed “pediatric research courts.” The courts would operate with regional or national jurisdiction and would render decisions on whether trials meet federal standards for ethical science.

“It would do this by hearing cases, publishing rulings, establishing precedents, [and] generalizing interpretations in a way that was truly public, meaningfully accountable, and transparent,” said Dr. Lantos, adding that such a court should have “regulatory teeth.”

“It should come up with an answer the way the Supreme Court comes up with an answer,” he said.

The council is scheduled to issue recommendations on the monitoring of child research ethics, although those recommendations won't have the force of law. It will be up to Congress to enact any changes, and it is unclear whether lawmakers will back drastic changes to the IRB system.

Regardless, others who spoke before the council agreed that IRBs have lost the ability to effectively monitor pediatric research.

“We've just got ourselves stuck into a situation that is going to get worse and worse and worse,” said Dr. Paul R. McHugh, a professor of psychiatry at Johns Hopkins University, Baltimore.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new–and sometimes radical–ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think it's time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a combined policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S donations by up to 75%. He also called for new policy that would let very ill patients choose to receive transplants from donors now deemed too high risk to donate, including injection drug users and men who have sex with men, who both have high rates of HIV and hepatitis.

Going to a new system that uses a “higher-brain” definition of death, rather than a cardiac definition–along with allowing donations from high-risk sources–could boost donations up to 200%, Veatch said.

Dr. Daniel W. Foster, a member of the council and a professor of internal medicine at the University of Texas Southwestern Medical Center, Dallas, pointed out that more than 65,000 Americans are waiting for kidney transplants, most of whom will die before a match is found.

“I think we have to do something radical about it,” he said.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new–and sometimes radical–ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think it's time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a combined policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S donations by up to 75%. He also called for new policy that would let very ill patients choose to receive transplants from donors now deemed too high risk to donate, including injection drug users and men who have sex with men, who both have high rates of HIV and hepatitis.

Going to a new system that uses a “higher-brain” definition of death, rather than a cardiac definition–along with allowing donations from high-risk sources–could boost donations up to 200%, Veatch said.

Dr. Daniel W. Foster, a member of the council and a professor of internal medicine at the University of Texas Southwestern Medical Center, Dallas, pointed out that more than 65,000 Americans are waiting for kidney transplants, most of whom will die before a match is found.

“I think we have to do something radical about it,” he said.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new–and sometimes radical–ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think it's time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a combined policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S donations by up to 75%. He also called for new policy that would let very ill patients choose to receive transplants from donors now deemed too high risk to donate, including injection drug users and men who have sex with men, who both have high rates of HIV and hepatitis.

Going to a new system that uses a “higher-brain” definition of death, rather than a cardiac definition–along with allowing donations from high-risk sources–could boost donations up to 200%, Veatch said.

Dr. Daniel W. Foster, a member of the council and a professor of internal medicine at the University of Texas Southwestern Medical Center, Dallas, pointed out that more than 65,000 Americans are waiting for kidney transplants, most of whom will die before a match is found.

“I think we have to do something radical about it,” he said.

WASHINGTON — Frustrated researchers are calling for the gutting of what they see as faltering institutional review boards now charged with the monitoring of medical research on children.

At a meeting of the President's Council on Bioethics, scientists told council members that institutional review boards (IRBs) are overburdened with bureaucratic red tape and are increasingly hamstrung in their efforts to scrutinize pediatric research.

The bureaucracy, they said, comes from federal laws laid down in the 1970s exerting tight IRB control over research protocols. The rules were enacted to prevent lapses in the wake of several well-publicized child research ethics scandals. Instead of protecting children, the rules have weighed down IRBs and made their deliberations arbitrary, experts charged.

Dr. Robert J. Levine, professor of internal medicine at Yale University, New Haven, Conn., and others warned that IRBs now spend much of their time exercising perfunctory annual reviews of ongoing research protocols. The reviews include scrutiny of each adverse event occurring during a trial.

Dr. John Lantos, a professor of pediatrics at the University of Chicago, said that IRBs routinely struggle to enforce federal rules requiring guardians of minor subjects to give informed consent for trials posing more than a “minimal” risk to patients. While the rules were meant to protect child subjects, IRB decisions on what constitutes a minimal risk have become “amateurish” and “idiosyncratic,” he said.

As a fix, Dr. Lantos urged the council to recommend a new system of what he dubbed “pediatric research courts.” The courts would operate with regional or national jurisdiction and would render decisions on whether trials meet federal standards for ethical science.

“It would do this by hearing cases, publishing rulings, establishing precedents, [and] generalizing interpretations in a way that was truly public, meaningfully accountable, and transparent,” said Dr. Lantos, adding that such a court should have “regulatory teeth.”

The council is scheduled to issue recommendations on the monitoring of child research ethics, though it will be up to Congress to enforce them by law.

WASHINGTON — Frustrated researchers are calling for the gutting of what they see as faltering institutional review boards now charged with the monitoring of medical research on children.

At a meeting of the President's Council on Bioethics, scientists told council members that institutional review boards (IRBs) are overburdened with bureaucratic red tape and are increasingly hamstrung in their efforts to scrutinize pediatric research.

The bureaucracy, they said, comes from federal laws laid down in the 1970s exerting tight IRB control over research protocols. The rules were enacted to prevent lapses in the wake of several well-publicized child research ethics scandals. Instead of protecting children, the rules have weighed down IRBs and made their deliberations arbitrary, experts charged.

Dr. Robert J. Levine, professor of internal medicine at Yale University, New Haven, Conn., and others warned that IRBs now spend much of their time exercising perfunctory annual reviews of ongoing research protocols. The reviews include scrutiny of each adverse event occurring during a trial.

Dr. John Lantos, a professor of pediatrics at the University of Chicago, said that IRBs routinely struggle to enforce federal rules requiring guardians of minor subjects to give informed consent for trials posing more than a “minimal” risk to patients. While the rules were meant to protect child subjects, IRB decisions on what constitutes a minimal risk have become “amateurish” and “idiosyncratic,” he said.

As a fix, Dr. Lantos urged the council to recommend a new system of what he dubbed “pediatric research courts.” The courts would operate with regional or national jurisdiction and would render decisions on whether trials meet federal standards for ethical science.

“It would do this by hearing cases, publishing rulings, establishing precedents, [and] generalizing interpretations in a way that was truly public, meaningfully accountable, and transparent,” said Dr. Lantos, adding that such a court should have “regulatory teeth.”

The council is scheduled to issue recommendations on the monitoring of child research ethics, though it will be up to Congress to enforce them by law.

WASHINGTON — Frustrated researchers are calling for the gutting of what they see as faltering institutional review boards now charged with the monitoring of medical research on children.

At a meeting of the President's Council on Bioethics, scientists told council members that institutional review boards (IRBs) are overburdened with bureaucratic red tape and are increasingly hamstrung in their efforts to scrutinize pediatric research.

The bureaucracy, they said, comes from federal laws laid down in the 1970s exerting tight IRB control over research protocols. The rules were enacted to prevent lapses in the wake of several well-publicized child research ethics scandals. Instead of protecting children, the rules have weighed down IRBs and made their deliberations arbitrary, experts charged.

Dr. Robert J. Levine, professor of internal medicine at Yale University, New Haven, Conn., and others warned that IRBs now spend much of their time exercising perfunctory annual reviews of ongoing research protocols. The reviews include scrutiny of each adverse event occurring during a trial.

Dr. John Lantos, a professor of pediatrics at the University of Chicago, said that IRBs routinely struggle to enforce federal rules requiring guardians of minor subjects to give informed consent for trials posing more than a “minimal” risk to patients. While the rules were meant to protect child subjects, IRB decisions on what constitutes a minimal risk have become “amateurish” and “idiosyncratic,” he said.

As a fix, Dr. Lantos urged the council to recommend a new system of what he dubbed “pediatric research courts.” The courts would operate with regional or national jurisdiction and would render decisions on whether trials meet federal standards for ethical science.

“It would do this by hearing cases, publishing rulings, establishing precedents, [and] generalizing interpretations in a way that was truly public, meaningfully accountable, and transparent,” said Dr. Lantos, adding that such a court should have “regulatory teeth.”

The council is scheduled to issue recommendations on the monitoring of child research ethics, though it will be up to Congress to enforce them by law.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new—and sometimes radical—ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think its time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a combined policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S donations by up to 75%. He also called for new policy that would let very ill patients choose to receive transplants from donors now deemed too high risk to donate, including injection drug users and men who have sex with men, who both have high rates of HIV and hepatitis.

Going to a new system that uses a “higher-brain” definition of death, rather than a cardiac definition—along with allowing donations from high-risk sources—could boost donations up to 200%, Veatch said.

Dr. Daniel W. Foster, a member of the council and a professor of internal medicine at the University of Texas Southwestern Medical Center, Dallas, pointed out that more than 65,000 Americans are waiting for kidney transplants, most of whom will die before a match is found.

“I think we have to do something radical about it,” he said.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new—and sometimes radical—ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think its time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a combined policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S donations by up to 75%. He also called for new policy that would let very ill patients choose to receive transplants from donors now deemed too high risk to donate, including injection drug users and men who have sex with men, who both have high rates of HIV and hepatitis.

Going to a new system that uses a “higher-brain” definition of death, rather than a cardiac definition—along with allowing donations from high-risk sources—could boost donations up to 200%, Veatch said.

Dr. Daniel W. Foster, a member of the council and a professor of internal medicine at the University of Texas Southwestern Medical Center, Dallas, pointed out that more than 65,000 Americans are waiting for kidney transplants, most of whom will die before a match is found.

“I think we have to do something radical about it,” he said.

The growing gulf between patients requiring organ transplants and the number of persons willing to give them is spurring some ethicists to call for new—and sometimes radical—ways to encourage donations.

The proposals range from loosening current restrictions on qualified donors to far more drastic measures, including “organ conscription,” which would require donations from all who die with adequately healthy body parts.

Some ethicists even are calling for debate on changing the legal definition of death to allow patients in permanent comas or vegetative states to become candidates for donation before cardiac death.

Transplant list wait times have increased dramatically in the United States. More than 92,200 persons were on U.S. waiting lists as of early May. That's nearly five times the number waiting a decade ago, according to the United Network for Organ Sharing, the nonprofit group that oversees organ allocation in the United States.

Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.

The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice whether or not to donate before receiving a driver's license.

Federal law bans offering money or other inducements in exchange for organs. But policy makers should consider altering the law to allow for new incentives, said Robert Veatch, Ph.D., a professor at the Kennedy Institute of Ethics at Georgetown University, Washington.

Dr. Veatch calls an organ conscription policy the “nuclear option.” But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs.

“There are too many people dying. I think its time to begin limited experiments with cash payments,” he said at a meeting of the President's Council on Bioethics.

But a cash-payment system of organ procurement is strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital and a professor of surgery at Harvard, both in Boston, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the Organ Procurement and Transplantation Network/United Network for Organ Sharing, would offer “staunch opposition” to any congressional attempt to legalize a market in human organs.

“That [waiting] list is growing because of inadequate medical care, and it's not just solvable by buying organs,” Dr. Delmonico, also president of the board for OPTN/UNOS, said.

Others warn that assigning organs market value would undermine human dignity. “Isn't there really something disquieting about entering into a society in which certain parts of the body are treated as alienable things like automobiles?” asked council member Dr. Leon R. Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.

Still, Dr. Veatch predicted that a combined policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S donations by up to 75%. He also called for new policy that would let very ill patients choose to receive transplants from donors now deemed too high risk to donate, including injection drug users and men who have sex with men, who both have high rates of HIV and hepatitis.

Going to a new system that uses a “higher-brain” definition of death, rather than a cardiac definition—along with allowing donations from high-risk sources—could boost donations up to 200%, Veatch said.

Dr. Daniel W. Foster, a member of the council and a professor of internal medicine at the University of Texas Southwestern Medical Center, Dallas, pointed out that more than 65,000 Americans are waiting for kidney transplants, most of whom will die before a match is found.

“I think we have to do something radical about it,” he said.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

The Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Doctors narrowly dodged a similar cut in January when Congress repealed it in the budget bill.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be "substantially rewritten" by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's Democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year.

"They're not going to give the raises the doctors want and the hospitals aren't going to get cut as much as they think," he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. "It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time," said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. "If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients," AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel, which is known as the RVS update committee, currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes. But MedPAC chair Glenn Hackbarth told reporters that the physicians on the committee tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and to make "independent" recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

"It's been a concern of ours that the current process is skewed," he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RVS update committee, "it should represent current practicing physicians," Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

The Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Doctors narrowly dodged a similar cut in January when Congress repealed it in the budget bill.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be "substantially rewritten" by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's Democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year.

"They're not going to give the raises the doctors want and the hospitals aren't going to get cut as much as they think," he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. "It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time," said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. "If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients," AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel, which is known as the RVS update committee, currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes. But MedPAC chair Glenn Hackbarth told reporters that the physicians on the committee tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and to make "independent" recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

"It's been a concern of ours that the current process is skewed," he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RVS update committee, "it should represent current practicing physicians," Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

The Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Doctors narrowly dodged a similar cut in January when Congress repealed it in the budget bill.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be "substantially rewritten" by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's Democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year.

"They're not going to give the raises the doctors want and the hospitals aren't going to get cut as much as they think," he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. "It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time," said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. "If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients," AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel, which is known as the RVS update committee, currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes. But MedPAC chair Glenn Hackbarth told reporters that the physicians on the committee tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and to make "independent" recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

"It's been a concern of ours that the current process is skewed," he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RVS update committee, "it should represent current practicing physicians," Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Doctors narrowly dodged a similar cut in January when Congress repealed it in the budget bill.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

However, hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of all hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's Democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year. “They're not going to give the raises the doctors want and the hospitals aren't going to get cut as much as they think,” he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. “It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time,” said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel known as the RVS Update Committee (RUC) currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes.

MedPAC chair Glenn Hackbarth told reporters that physicians on the RUC tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and make “independent” recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

“It's been a concern of ours that the current process is skewed,” he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RUC, “it should represent current practicing physicians,” Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Doctors narrowly dodged a similar cut in January when Congress repealed it in the budget bill.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

However, hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of all hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's Democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year. “They're not going to give the raises the doctors want and the hospitals aren't going to get cut as much as they think,” he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. “It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time,” said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel known as the RVS Update Committee (RUC) currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes.

MedPAC chair Glenn Hackbarth told reporters that physicians on the RUC tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and make “independent” recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

“It's been a concern of ours that the current process is skewed,” he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RUC, “it should represent current practicing physicians,” Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Doctors narrowly dodged a similar cut in January when Congress repealed it in the budget bill.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

However, hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of all hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's Democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year. “They're not going to give the raises the doctors want and the hospitals aren't going to get cut as much as they think,” he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. “It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time,” said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel known as the RVS Update Committee (RUC) currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes.

MedPAC chair Glenn Hackbarth told reporters that physicians on the RUC tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and make “independent” recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

“It's been a concern of ours that the current process is skewed,” he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RUC, “it should represent current practicing physicians,” Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year.

MedPAC also recommended that hospitals get a 2.95% increase for treating Medicare's 42 million beneficiaries. That would pare back the projected growth in hospital payments by nearly half a percent.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals may have little to fear this year, according to several key members of Congress.

At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Physicians narrowly dodged a similar cut in January when Congress repealed it in the budget authorization bill.

MedPAC also recommended that hospitals receive a 2.95% increase for treating Medicare's 42 million beneficiaries. An increase of that size would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals might have little to fear this year, according to several key members of Congress. At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year. “They're not going to give the raises the doctors want—and the hospitals aren't going to get cut as much as they think,” he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. “It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time,” said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel, called the RVS update committee (RUC), currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes. But MedPAC chair Glenn Hackbarth told reporters that physicians on the RUC tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and make “independent” recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

“It's been a concern of ours that the current process is skewed,” he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RUC, “it should represent current practicing physicians,” Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Physicians narrowly dodged a similar cut in January when Congress repealed it in the budget authorization bill.

MedPAC also recommended that hospitals receive a 2.95% increase for treating Medicare's 42 million beneficiaries. An increase of that size would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals might have little to fear this year, according to several key members of Congress. At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year. “They're not going to give the raises the doctors want—and the hospitals aren't going to get cut as much as they think,” he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. “It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time,” said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel, called the RVS update committee (RUC), currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes. But MedPAC chair Glenn Hackbarth told reporters that physicians on the RUC tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and make “independent” recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

“It's been a concern of ours that the current process is skewed,” he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RUC, “it should represent current practicing physicians,” Dr. J. Edward Hill, the AMA president, said in a statement.

The committee advising Congress on Medicare payments has called for reimbursement increases for physicians and hospitals next year, but is proposing to slow the growth rate for hospital payments.

In its March report, the Medicare Payment Advisory Commission (MedPAC) called for a 2.8% increase in payments to doctors, instead of the 4.6% cut required by law next year. Physicians narrowly dodged a similar cut in January when Congress repealed it in the budget authorization bill.

MedPAC also recommended that hospitals receive a 2.95% increase for treating Medicare's 42 million beneficiaries. An increase of that size would pare back the projected growth in hospital payments by nearly half a percent. The commission noted that a slowdown was needed to help control the program's rising costs.

The proposal is in line with the White House fiscal 2007 budget, which calls for $480 million in hospital payment cuts for 2007 as part of efforts to control entitlement spending. Hospitals have complained bitterly that they already lose money on Medicare, and that further cuts could drive some of them out of business.

But hospitals might have little to fear this year, according to several key members of Congress. At a Capitol Hill hearing, Rep. Nancy L. Johnson (R-Conn.) said that half of hospitals already operate in the red on money from Medicare patients.

In an earlier interview, Rep. Johnson, who chairs the House Ways and Means subcommittee on health, said that President Bush's budget is likely to be “substantially rewritten” by Congress.

Congress approved $6.4 billion in cuts to Medicare over 5 years in February. The White House budget called for $36 billion more in cuts by 2011.

California Rep. F. Pete Stark, Rep. Johnson's democratic counterpart, suggested that Congress will be unwilling to back any more significant changes to Medicare in an election year. “They're not going to give the raises the doctors want—and the hospitals aren't going to get cut as much as they think,” he said in an interview.

Sen. Gordon H. Smith (R-Ore.) agreed. “It's very bleak for doing anything. In sessions that precede elections, it's all politics all the time,” said Mr. Smith, a member of the Senate Finance Committee.

The American Medical Association praised MedPAC's call for higher physician payments. “If enacted by Congress, this new MedPAC recommendation will help physicians continue to treat Medicare patients,” AMA board member Dr. Duane Cady said in a statement.

But the group is likely to be less impressed by a renewed MedPAC recommendation that calls for a new committee to advise Medicare on the resource-based relative value scale (RBRVS) that sets reimbursement for medical services.

An AMA panel, called the RVS update committee (RUC), currently makes recommendations on payment updates for hundreds of treatment and diagnostic codes. But MedPAC chair Glenn Hackbarth told reporters that physicians on the RUC tend to counsel for increases and that MedPAC members want a new committee within the Centers for Medicare and Medicaid Services to review the AMA's work and make “independent” recommendations on code values.

Mr. Hackbarth said MedPAC members worry that rising code values for some services, particularly specialty care, are robbing resources from the primary care and preventive services that Medicare is now hoping to emphasize.

“It's been a concern of ours that the current process is skewed,” he said.

If an additional expert panel is appointed to help identify services to be reviewed by the RUC, “it should represent current practicing physicians,” Dr. J. Edward Hill, the AMA president, said in a statement.