Sunday, November 01, 2009

Not Seeing the Forest for the Trees

Congress, in their efforts to be conciliatory to specialists, is now working to alienate primary care physicians, too:
(Medicare payment) Reductions will be made over four years rather than imposed at once in 2010, the U.S. Centers for Medicare and Medicaid Services said yesterday in a statement. In July, the agency said it planned to slice $1.4 billion, or more than 10 percent, in payments for each of the two specialties, triggering what an advocate promised would be a “tooth and nail” battle.

The administration argued that the lower reimbursements for specialists would make more dollars available for lower-paid non-specialists who can focus on preventing expensive, chronic illnesses. That would tame the growth in medical costs, one goal of President Barack Obama’s effort to remake the U.S. system of care. Under yesterday’s plan, family doctors and nurse practitioners would get half the proposed increase.
So while specialists won't be cut quite as bad, primary care will not see their efforts rewarded significantly either.

And yet, any real effort to look for simple ways to cut costs in health care system is ignored by Congress. One only has to look at the waste of health care dollars implicit in pharmaceutical direct-to-consumer advertising - and the fact that only two countries in the world (the U.S. and New Zealand) permit it - to see the hipocracy of the reform efforts underway. Instead, doctors are the easy target for "reform" as more and more ads for Viagra, Lipitor, and "P.A.D." flash accross our TV screens.

Sure it's not the only place costs can be cut. But how about ridding our system of such bloat before biting the hand that cares for us?



Anonymous said...

I agree about the advertising. But I can hear the screams from the far-right and many congressional Republicans - "socialism", "Marxism", "end of our American way of life", "government takeover".

Meantime, CBO has published results of anticipated savings from tort reform. I'm also willing to go along with that. But the savings are far short of Boehmer's figure.

A little "truthiness" would go a long way in our legislature's chambers.

Anonymous said...

yeah and maybe they could do after dme companies a little bit too?

Anonymous said...

Dr. Wes, I do not agree with a lot of what you say, but this time I am with you 100%. I have often wondered what doctors really thought about all the drug advertising. As a patient, I find it offensive and predatory, and believe it preys on people's fears. I have never gone to a doctor and asked for drug I saw on TV, but I can only imagine how many patients have done so. The advertised drugs are surely the most expensive ones on the market. What I don't understand, however, is why doctors would let themselves be manipulated in that way. Isn't it your responsiblity to act in the REAL best interest of the health of a patient (by saying "you", I do NOT mean to imply that you personally fall victim to this manipulation- I mean it in the plural, generic sense).

One request: when you quote a publication, could you please cite the source? Just as I don't believe every ad I see on TV, I don't believe everything I read, and I'm sure you don't either. If you have selected a source as believable, we would like to know about it.

And is that "hipocracy" a bit of doctor pun?

Anonymous said...

Re the third comment.

I have to believe that Dr. Wes, once again, is showing his creative side. The man does not make spelling mistakes.

Keith said...

Doc Wes,

We in primary care will gladly give up half our raise so that our specialist colleugues do not suffer too much. It is more than I can say the various specialty societies have done for primary care in the last two decades.

I did remind Maggie Mahar, who is convinced there will be a big push to increase primary care reimbursement, that I was still skeptical it would ever happen, and this just goes to show that any promised increase will likely be whittled away, much as has occurred under RBRVS (this too was supposed to raise the pay status of primary care as I recall).

I can almost hear the response of the president of the ACC when the politicians dangled this tidbit in front of him. Somehow, I will bet he did not chose to stand his ground and not allow primary care to get thrown under the bus to the benefit of his own membership. This is how the game is played and I have no great expectations for primary care or medicine in general since it has become a giant feeding frenzy of greedy interests plying the waters and influencing our national leaders.