Federal practice guidelines and clinical autonomy.

Congress established the Physician Payment Review Commission (PPRC) in 1986 to provide recommendations on the reform of Medicare physician payment. PPRC recommendations to Congress played a major role in shaping the physician payment reform legislation that was enacted as a part of the Omnibus Budget Reconciliation Act of 1989. Dr Brame, a former president of the Texas Medical Association (1986-1987) is a member of the PPRC.