Thomas A. Gustafson, PhD

Thomas A. Gustafson, PhD

Senior Policy Advisor*

Thomas Gustafson, PhD, concentrates on Medicare reimbursement and related issues and on health policy generally.

Dr. Gustafson began his distinguished 30-year career at the United States Department of Health and Human Services (HHS) in 1976. He joined the HHS as an economist concentrating on retirement and welfare issues, and, in 1985, he moved to the Health Care Financing Administration, now the Centers for Medicare & Medicaid Services, where he held several executive posts responsible for Medicare and Medicaid legislation, strategic planning, research and demonstrations, and development and implementation of regulations.

In 2003, Dr. Gustafson was named Deputy Director of the Center for Medicare Management (CMM), which coordinated the fee-for-service portion of the Medicare program and set payment rates for more than a million providers. At CMM, Dr. Gustafson supervised coding and payment policies affecting approximately US$300 billion in Medicare spending on hospitals, physicians, nursing facilities, home health agencies, and other providers. He led the development and introduction of the hospital outpatient prospective payment system and oversaw major improvements in Medicare’s other payment policies and systems. He oversaw a sweeping reform, intended to improve accountability and efficiency, of Medicare’s administrative structure for paying claims. From 2006-2007, he served as Acting Director of the CMM.

Since joining the firm, Dr. Gustafson has advised health-care providers, device and pharmaceutical manufacturers, and trade associations on a wide array of issue areas, including: laboratory coverage, coding and payment; launch and reimbursement issues for pharmaceutical products; physician, outpatient hospital and end-stage renal disease reimbursement systems; and accountable care organizations.

Perspectives

Trump Administration Issues Blueprint to Lower Drug Prices and Reduce Out-Of-Pocket Costs
Advisory
The 21st Century Cures Act
Advisory
CMS Plans to Overhaul Medicare's Beneficiary Identification System: What You Need to Know
Healio.com
Physician Payment Under the Physician Fee Schedule
Reimbursement 101: A Primer on Medical Device Reimbursement, Washington, DC
Compliance with Final PAMA Rules - Private Payor Data Reporting: What Information Must Be Reported, When, and How?
Arnold & Porter LLP
More

Recognition

US Presidential Rank Award (2000, 2004)

Credentials

Education
  • BA, Williams College, 1969, magna cum laude
  • PhD, Economics, Yale University, 1982
Admissions
  • *Not admitted to the practice of law
Government and Military Service
  • Deputy Director, Center for Medicare Management, Centers for Medicare & Medicaid Services
  • Director, Hospital & Ambulatory Policy Group, Centers for Medicare & Medicaid Services
  • Deputy Director, Office of Research and Demonstrations, Centers for Medicare & Medicaid Services
  • Deputy Director, Office of Legislation, Centers for Medicare & Medicaid Services
Activities
  • Member, American Economics Association

  • Member, American Health Lawyers Association

  • Member, National Academy for Social Insurance

Overview

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