Friday, April 05, 2013

The Physician Payment Reform I'd Like to See

In case you missed it, the "National Commission on Physician Payment Reform" issued their glossy, industry-produced white paper on 4 March 2013 containing twelve recommendations to provide a five-year "blueprint" for transitioning physician payment methods to a "blended payment system that will yield better results for both public and private payers, as well as patients."

Rules Are Only for the Little People

I was alerted to the presence of this report after an "Online First" article entitled "Phasing Out Fee-for-Service Payment" by Steven A. Schroeder, M.D., and William Frist, M.D. for the so-called National Commission on Physician Payment Reform was published March 27, 2013 in the New England Journal of Medicine.  (So much for Journal's Ingelfinger Rule that prevents the publication of works previously published elsewhere.  It is interesting that Dr. Schroeder, the lead author of this New England Journal of Medicine article, failed to disclose that he currently serves as an editor for the New England Journal of Medicine.  No doubt he "exempted" his own piece from the Ingelfinger Rule because this 5-year, 12-step program [pun intended] was felt to be "public-health information that needs to be brought to the public's or profession's attention without delay.")

But the concerns about this article and its authors' backgrounds go much further.  We should realize that this 14-member "National Commission on Physician Payment Reform" was supposedly created out of thin air by an obscure general internal medicine group called the Society of General Internal Medicine (SGIM) comprised of approximately 3000 academic internists. We are led to believe the SGIM doctors chose their 14-member National Commission with physician payment reform solely as their guiding light.  And why not?  What physician wouldn't want to enjoy not being paid for the work they do?

Whose Interests Are Served By Physician Payment Reform?

So let's look at a few of the members of their "National Commission."

First and foremost is the "honorary" commissioner and former US Senator, William H. Frist, MD.  Doctors should ignore Dr. Frist's deep, deep ties to Hospital Corporation of America (HCA), the largest operator of health care facilities in the world.  After all, he only held a few blind trusts that his 2005 financial disclosure form valued between $15 million and $45 million.  And we should ignore the fact that he sold his interests in those trusts just one month before HCA stock price precipitously fell in 2005 and was subject to a SEC investigation.  To be fair, no wrongdoing was ever found.  But that hasn't stopped our "own" Dr. Frist from serving as partner and Chairman of the Board for Cressey and Company, LP, a private investment firm based in Chicago and Nashville "focused on the health care industry."

I'm seeing this effort for physician payment reform as being all about patients, aren't you?

But there's more.

Another member of the 14-member commission is none other than Dr. Troyen A. Brennan.  Dr. Brennan is Executive Vice President and Chief Medical Officer of CVS Caremark, the nation’s largest pharmacy health care company.  In this role, he oversees the company’s MinuteClinic, Accordant Health Care, clinical and medical affairs, and health care strategy.  CVS was so happy about his appointment to this National Commission that it even sent out a press release!  While I have no idea about Dr. Brennan's salary with CVS, I'd bet my medical degree that his salary is higher than that of most US physicians.  One only has to look at the relative salary and benefits that CVS Caremark's Chief Executive Officer earns and you see why I am confident about Dr. Brennan's relative salary.  I mean, who wouldn't want that private jet?  No doubt America's doctors will feel nothing but goodwill and fuzzy feelings about helping to fund the nice retirement package CVS routinely gives to its chairmen as a result of Dr. Brennan's efforts on the Commission.

Another member of the Commission is none other than Dr. Lisa Latts.  Dr. Latts also serves as the Vice President of Public Health Policy for WellPoint, Inc, the largest managed health care, for-profit company in the Blue Cross and Blue Shield Association.  They insure nearly 11% of the US population.  But one could argue, cheap doctors should mean cheaper insurance, right?   I don't think so.  After all, it's not easy to keep paying for retirement packages for your retiring CEO's that cost $20.6 million.  But no worries.  Wellpoint's new CEO's compensation will include just an annual base salary of only $1.25 million with eligibility clauses for an incentive bonus of up to 300% of that amount, not to mention that he is also getting equity-incentive grants for 2013 with an $8 million target value, restricted shares with a grant date fair value of $1.5 million as "an inducement to joining" the company and a "make whole" payment currently estimated at almost $3.6 million for compensation he'll forfeit in switching jobs.   Poor guy. 

So physician payment problems really ARE a major cause of those high health care prices today, doctors, don't you see? 

So let's hear it for the Society of General Internal Medicine and the New England Journal of Medicine for providing their white paper to America on how to implement physician payment reform!  I'm so glad to see that all of the members of the National Commision of Physician Payment Reform were willing to do their part to sacrifice part of their hard-earned salary on behalf of our national health care cost crisis, too, aren't you?

Oh, wait...

A Solution?

Look, here's my idea: stop redirecting the truth about what's really eating up the cost of health care.  It's time we address the excessive costs of all of these excessive middle management healthcare leeches.  If you want physician payment reform, stop creating ridiculous fronts called "National Commissions" of doctors that act has our modern-day Physician Inquisitors.

Instead, pay us what we're each worth (trust me, it's not that hard to find out and it sure as heck doesn't take a year of meetings held at expensive hotels that results in just one white paper with 14 co-authors that carry innumerable conflicts of interest into the discussion.)  Pay us by the hour at our fair rate. And pay us for everything we do for our patients: every minute we type at the computer, answer a health-related e-mail, sit on a phone, sit at their bedside, remove an brain tumor, teach a medical student, look up labs, grow our practice, explain a procedure, or care for your mother after hours, too.  Then pay us double for every minute we take call after hours. 

Dissolve the RUC.  Flush the SGR formula that is never followed anyway and wastes too much time and money each year.  Rid us of stupid proprietary CPT procedure codes that must be linked (properly, mind you) to a ridiculous list of ICD-10 procedure codes so we can be paid.

Keep it simple, stupid. It's not that hard to do.

It's only hard to make changes to our current physician payment system when everyone that wants "physician payment reform" also wants to make sure they get their part of our already dwindling pay.



Anonymous said...


Bill H said...

Last year I had an echo study, plus stress/echo ins $314 + $0 copay based on CPT. Done in cardiologist office.

This year hospital took over that operation. For echo study ONLY ins paid $312 + $50 copy based on Revenue codes

Anonymous said...

Life is too short to ride a sinking ship to the bottom, especially when you don't have to.

I hear your frustration. I know you speak for thousands of others. I just don't understand why Doctors as a group put up with it.

I also don't understand why some Docs have been such a big part of driving the changes - consolidating practices, moving from independent small groups to employees of big medicine, serving on pricing boards, the list goes on.....

It's hard to watch a group of professionals eat their own without wondering why the eaten stick around to serve the eaters.

I applaud you for sticking with it, but I can't say I'd do the same.

Life's too short, and you can't take the extra with you when you die.

Anonymous said...

Dr. Brennan made $575,000 is salary for 2009. Total comp was $2.9M. This was found on EDGAR online. He didn't make the cut for comp disclosures in later years, but one would assume it has only increased.

Anonymous said...

Anyone know Don Berwick's salary at his 'institute'?

betsy said...

Dr Wes- As regards Senator Frist.

About three years ago the New York Times did an expose of the LTAC (Long term acute care) industry, and about how poorly regulated it was and how lethal its hospitals were. Senators Baucus and Grassley were to set up an investigative committee to look into these hospitals, which feasted on Medicare dollars-

Did it happen?
Of course not.
The biggest of the LTAC chains put Dr Bill Frist on its Board of Directors. He earned his money. The Senators backed off. Nothing was done. No committee. Down the memory hole.

This is how things are done.

Anonymous said...

Yes, indeed payment to doctors only contributes a very small percentage to the cost of health care in this country.I am a solo doctor (gynecologist)practicing holistic and comprehensive health care to women. I am a dying breed.
I took a tremendous financial hit to practice the last 15 years of my career in a way which nurtures my compassion as a physician.
I spend time with patients and I listen.
The way medicine is heading in this country I fear for my life when I am old and feeble.
As Dr. Wes points out in great detail, it is the salaries and profits of the medical health insurance companies (and the related industries), which are sucking money from meeting patient needs and compensating physicians for the cost of doing business as inflation continues.