The Senate - now that the Finance Committee has passed the collection of thoughts on healthcare known as the Baucus "Bill" - is looking to a "permanent" fix in the Medicare physician payment schedule. This is transparently being done to buy physician support for the larger healthcare reform effort, and it's laughable.
As you may or may not know, the last Medicare payment "fix" involved something known as the SGR, for sustainable growth rate formula for determining annual adjustments in provider payments. The American Academy of Orthopaedic Surgeons has a good summary here. It was flawed from the moment it was instituted, and has never been fixed. As a result, every year it calls for cuts in physician payment rates - in an environment where overhead and salaries for employees continues to increase. Congress has acted annually to block the cuts, but has let them accumulate to the point where, without a fix, next year will call for a 21% reduction. Oh my.
Now, with health reform on the table, the Democratic Congress and Obama Administration are looking for physician support for their efforts, so they're making an effort to do something that should have been done 10 years ago, and fix the formula.
The Senate is poised to take action on a costly bill to hike Medicare payments to physicians just weeks before bringing a sweeping healthcare overhaul to the floor.
No. They're looking to prevent the 21% cut. That's not a "hike" in payments.
Next year, without congressional intervention, Medicare’s fees to physicians would drop by 21 percent. In addition to their desire to prevent those cuts, Democrats are eager to win the support of physicians for healthcare reform. The American Medical Association (AMA) has already endorsed the House healthcare reform bill, which contains a $245 billion payment fix.
See, I told you. And I'm sorry, but I can't be bought that easily. And the AMA found out after they came out in support based on that "fix" that most physicians feel the same. The right thing to do is to fix the SGR formula. If such a poison pill called for cuts in union salaries at, say, GM and Chrysler they would have fixed it long ago. But doctors? We don't give a rat's behind about them. Until ...
Until they need support for a reform that calls for - I'm not kidding - cutting physician Medicare payments by 25% with no future inflation adjustments. No doctor should support this based on that alone. And if you're going to remove that provision, then the CBO better re-score the Baucus "Bill". I can't be bought. The Democrats here are actually trying to get something for nothing. They'll never be able to let the Medicare 21% cut go through as too many MD's would drop Medicare patients, and the seniors - who regularly vote in great numbers - would take it out on them at the ballot box.
This is nonsense, and I urge my fellow physicians to stand firm. If this payment fix is passed as it should be, assess the pros and cons of health reform on its own merits, and don't let such a temporary financial fix, one that merely avoids the threatened cuts, influence your decision making.
10/15/09 1740: It's not just doctors. The administration thinks it can buy the support of seniors as well. Mind you, all of this buying is being done with your tax dollars.