Friday, November 18, 2011

A Bias Toward Physicians

Honor a physician with the honor due unto him for the uses which ye may have of him: for the Lord hath created him.

No book is genuinely free of political bias.
George Orwell (1903-1950), Politics and the English Language

November 18, 2011 - Recently I was asked to give a speech before a distinguished physician group about my book The Health Reform Maze: A Bluprint for Physician Practices (Greenbranch Publishing, 2011). The only condition for the speech was:” Give an unbiased opinion of physicians.”

This, I said, I could not and cannot do. I have a bias toward physicians.

Being one of them, I contend we have not been given a fair shake by politicians and the media. Physicians are said to be greedy and principally responsible for high health costs.

Given 12-14 years to prepare for our profession (college, medical school, residency, and fellow ship), educational debts of $150,000 to $200,000, patient demands for the very best of care, lawyer scrutiny of that care, malpractice premiums of $10,000 to $100,000, continuing education requirements, and third party utilization rules raising overhead costs by 50% or more, I understand why physicians are justifiably outraged by Congress’s annual threats since the 1997 implementation of the SGR (sustainable growth rate) formula to slash their incomes. This year the slash of 27.4% of physicain payments is slated to take effect on January 1, 2012.

MedPAC (Medicare Payment Advisory Commission) has offered an alternative proposal to SGR – a 17% cut of specialists’ fees (2/3s of American physicians are specialists) and a freeze of primary care physician fees over 10 years. This is unacceptable.

I agree with this excerpt from Jeff Goldsmith’s blog of yesterday entitled, “MedPAC’s SGR Solution: Bad Medicine For A Chronic Problem.” Goldsmith is president of Health Futures, Inc, in Charlottsville, Virginia.

The Medicare Payment Advisory Commission (MedPAC) is the closest thing Congress has to adult supervision on important health policy questions. The Commission commands bipartisan respect both for its record of sound policy advice and for its leadership.

With its October recommendations, MedPac attempted to solve the sustainable growth rate (SGR) physician payment formula budget crisis by spreading its more than $300 billion cost beyond the physician community. More than two-thirds of the burden would fall on hospitals, pharmaceutical and device manufacturers and, significantly, on Medicare beneficiaries themselves. Clearly MedPac’s intent was to widen the circle of pain.

However, a significant portion of the burden, over $100 billion, would still be borne by the physician community through 17 percent reductions in specialists’ fees and a ten-year freeze on primary care fees.

If implemented, MedPac’s policies will give rise to a festival of unintended consequences: weakening multi-specialty group practices (which rely upon specialist comp to cross-subsidize their primary care services); winding down private practice-based primary care medicine; accelerating the hospital roll-up of medical practices while widening hospitals’ losses on the practices they already own; and triggering a further wave of ill-timed cost shifting to private insurers.

Tweet: MedPAC recommends a 17% cut in specialists’ fees and a freeze in Primary Care fees over the next 10 years, a proposal most doctors reject.

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