Wednesday, January 02, 2013

The Fix That Failed

The new "fiscal cliff" legislation hailed by some as a "one-year doc fix" of the scheduled 26.5% sustainable growth rate (SGR) cut that was scheduled to take effect on 1 January 2013, has passed the Senate and House as part of the American Taxpayer Relief Act (HR 8) goes to President Obama for his likely signature.

But was this "one-year doc fix" really a fix?

Not at all.

In fact, once again Congress has failed to resolve the ever-present sustainable growth rate cuts that repetitively surface year after year by kicking the proverbial can down the road another year.

The cost of the one year patch will be $25.1 billion dollars over 10 years and will be paid for almost entirely by health care cuts in other areas.

  • Hospitals (increasingly doctor-employers now, remember?) will see audits of their billings increase as efforts to recoup some $10.5 billion of "overcoding" charges are seen as the largest source of revenue for the one-year "fix."

  • Hospitals will also see an extension of lower Medicaid payments to hospitals that treat a high number of uninsured or low-income beneficiaries, known as "disproportionate share hospitals" to find savings of about $4.2 billion.

  • Another $4.9 billion offset will be applied to the lowered bundled payments given for patients with end-stage renal disease - some of the sickest people receiving services from Medicare.

  • Also another $1.8 billion will be "saved" to offset the "fix" by reducing payments for multiple procedures that are performed on the same day with patients.  Look for more ICD-9 (or ICD-10) code changes for the new year. 

  • Also, look for an even greater crackdown on imaging studies as another $800 million has to be found to pay for the "fix."

  • And there's more: the complete list of payments for the "fix," drawn almost exclusively from health care alone, can be found here.

  • Finally, doctors can expect revenue to stay flat result of this "fix" from Medicare, meaning that the payments received will not address costs imposed by annual inflation.  (You well-paid primary care doctors, are you listening?)
So you see, the "doc fix" is in for another year alright ...

... one that is assured to get even harder to really fix next year.



Anonymous said...

another reason I enjoy this blog..
reflections like this one..
used to tell my students in the 70's way before abortion and euthanasia became not only accepted but promoted that we would get to the point where human beings are defined exclusively by their ability to produce..i.e. work in order to be taxed. In your column today I read between the lines and see " death panel". 7 years ago a friend's 73 yr.old husband diagnosed with cancer was told by an HMO, " You have had a nice long life. Why not go home and put your affairs in order." She found him another doc.

Anonymous said...

For this year, stent implantation was cut 20%. It now cost roughly the same to have your pet spayed as it does to have a stent placed in your proximal LAD to abort an acute MI.

I understand shared sacrifice. We rich docs have seen cuts after cuts (especially in cardiology). My practice was no longer viable and I am now a ward of the hospital.

What bothers me the most is being vilified in the MSM and by politicians like Obama who say mean spirited things like 'cutting patient's legs off for $50-60,000'. The CV surgeons went through the same cuts around the time of Hiliarycare. As a result, those residency programs can't even fill with residents. I expect that cardiology will go through the same dislocation when students/residents realize that they will spend four or five years in fellowship to earn the same as a concierge IM doc. This is a basic economic decision. Society cannot expect that specialists will be available; however, this is, of course, the intent.

Anonymous said...

In CRAZY CALIFORNIA where it is not uncommon to have husband-wife physicians earning a total of a bit over $450,000 will have a total (Fed and State) income taxed at 54%. Cost of living (and dying) is already exorbitant and add fuel tax, sales tax, property tax, etc. I would not doubt a rapid exodus of specialists from CRAZY CALIFORNIA because of the hatred against the producers and caring "rich" physicians. When we leave, the hateful "gimme" obamaphone people will have to suck it up. We're not coming back!