Friday, March 27, 2015

Is the Medicare "Doc Fix" Really So Appealing?

It was like magic, a vote was held in the House of Representatives on the Medicare "Doc Fix" and moments later, my inbox was filled with press releases from the American College of Cardiology and the AMA.  A few seconds later, a somewhat more tempered press release from AARP arrived, urging more revisions to the bill as it passed to the Senate for approval.

This isn't the first time in history Medicare has changed how it pays physicians. Nor will it be the last. But practicing physicians should be fully aware of what the new bill has in store for us.  After all, busy physicians aren't necessarily working on the latest legislative efforts on Capitol Hill.

So it should come as no surprise that working doctors (and the patients they treat) are on the doctor payment menu rather than truly sitting at the legislative negotiating table.  From the National Review:
Some Republicans are also enthusiastic about the “reforms” the bill would make to Medicare’s physician-payment system. They shouldn’t be. Today’s system is the result of three decades of technocratic good intentions gone terribly awry. In 1989, Congress adopted the “resource-based relative value scale” as the fundamental building block for determining physician fees. The new system was supposed to accurately assess how much time, effort, and training physicians put into taking care of a patient, and pay them accordingly. The result has been arbitrary and irrational payments that have heavily favored procedure-driven medicine over prevention and primary care.

Now we are told that the federal government is going to find a way to pay physicians based on quality and value, using all manner of new technocratic methods to do so. Data will be collected, expert panels convened, and regulations issued, and supposedly that will lead to a better system of physician payments. But there’s no reason to believe the Medicare bureaucracy will be any better in the future than it has been in the past in setting physician fees. The real danger here is that the federal government will use the new authorities provided in the law to become the official arbiter of what constitutes “quality” in physician care. That’s a recipe for getting the exact opposite of what the law’s authors intend.

As to the “reforms” in Medicare, there’s far less there than one might hope. The first provision would only modestly adjust upward the premium payments for a small number of upper-income households. Elderly couples with incomes between $267,000 and $320,000 per year would see their Medicare premiums rise from 50 to 65 percent of the value of their Part B insurance. Couples with incomes above $320,000 but below $428,000 would see their premiums rise from 65 to 75 percent of the implicit total premium for their coverage. What’s important to remember about these kinds of reforms is that the elderly are generally retired. They aren’t working, and many of them are living off their accumulated savings, which they draw on as needed. They don’t have substantial incomes, even if they have substantial assets. So income-tested premiums of the kind envisioned in the SGR deal affect very few people — only 2 percent of all Medicare beneficiaries. And the provision doesn’t become effective until 2018.
When the federal government is "going to find a way to pay doctors based on quality and value," ask yourself one question: "Value" to whom?

Patients will lose doctors and doctors will lose parts of their careers as this "fix" is enacted.

Consider calling your Senator at 1-877-996-4464 and ask them that question:  "'Value' to whom?"  

If they stumble, even momentarily, ask them to vote "no."



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Anonymous said...

All the medical societies are lobbying hard for this bill, so, ipso facto, it has to be bad for physicians and patients.

Valerie said...

Very well said, Wes! I agree 100%!

Anonymous said...

1. This is a dream for the bureaucrats who will make millions defining value--think Gruber.
2. I have a strange feeling that 'value' will be defined as compliance with MOC and board certification.
3. How about EMR use and more importantly compliance with MU-infinity. This is where you create of company that invents tests that the staff is required to take. Clearly, passing this test ensures quality. Don't forget to create some data that validates your tests.
4. Another possibility is to codify your company's business plan by placing a former senator on your board of directors. Does it matter what your company does? It can be something as complex as mailing forms to your patients who rate your competence based upon whether you prescribed their narcotics as requested.