Wednesday, December 19, 2007

Band Aids are NOT good healthcare for Seniors

While most of the country was completely unaware, a very important piece of legislation was passed by the U.S. Senate yesterday. However, it is only a short-term band-aid to a major gash in the U.S. health care system... a wound affecting over 44 million Americans plus 1500 new Americans every day. What is it? Read on my friend!

Medicare reimbursement for physicians. Now, I know that may sound selfish coming from a future physician, but let me explain the facts. Physicians in this country were due for a 10.1% reimbursement cut on January 1st, which has now been pushed back 6 months to give legislators more time to resolve an issue that they have stalled on, and band-aided every year for the past 6 years. While medicare reimbursement rates to other types of health care providers have gone up over the past few years, the rate for physicians and private insurers who provide medicare type benefits to seniors have stayed flat. The only reason they have stayed flat and not decreased is the repetitive band-aid approach. The problem is that the cost of operating a medical clinic is going sky high, so if reimbursement rates do not follow it becomes very difficult for a physician to give time to medicare patients or to accept new medicare patients (think Baby Boomers hitting retirement...). As a future physician, and the son of parents getting closer to medicare age, I am deeply concerned about the impacts of medicare reimbursement on quality of care for our seniors!

Many physicians are practicing in areas where their patient base is 30, 40, or even greater than 50% medicare! So many physicians are facing the ethical dilemma of not seeing Medicare patients, or having to charge them an extra fee to make up the difference, or reducing their visit time with medicare patients to see more patients total. None of these options are good options, especially if you know somebody who is on medicare, will be on medicare in the near future, or if you are on medicare yourself.

The 10.1% pay cut that was due on January 1st will still take place at the end of June if Congress doesn't finally act to fix this thing. In fact, the next 8 years are scheduled for 5% cuts each year under the current algorithm that bases physician reimbursement on whether or not spending growth is more or less than an economics-derived target rate. If spending growth in health care exceeds the target rate, physicians get a pay cut. The problem is that everything in health care is getting more expensive, at a rate faster than economic inflation. So ultimately we are looking at a 40% pay cut from Medicare by 2016. It is pretty much a guarantee that Physicians will not see Medicare patients regularly if that is the case. Best-case scenario is that they have their mid-level providers like Physician Assistants and Nurse Practitioners see them, but -40% will still make that virtually impossible from a business standpoint.

Medicine should not be a business and physicians should not have to worry about what patients they can and can't see in order to stay in business. The medicare system as it stands is going to force Physicians to put business ethics above medical ethics and that is wrong. We need our congressional and senatorial leaders to make this change for the future of our seniors and our health care system. We need our next president to care about health care for seniors, reducing health care costs (reduce costs for physicians and reimbursement cuts are not a problem), and improving the quality of health care in America!


ATF said...

I agree with the last paragraph. However, it seems obvious to me that the cost of healthcare can't continue to increase much faster than inflation and still be easily received by everyone. Eventually, the money runs out. The best things cost a lot of money. Unfortunately, healthcare is no exception. I don't think physicians should have to absorb the entire gap between inflation and rising healthcare costs, but it seems like they have to absorb some of it. The problem seems to be that there are two conflicting ethics at work. One which says that every person is entitled to the best possible healthcare, and another ethic that says that developments in medicine and medical research that extend people lives or make people's lives more comfortable should never be limited by money. It seems inevitable that these two ethics can't continue to operate unless you have an endless supply of money. My thoughts anyway.

Rick the Medical Student said...

Yes, you make a good point that every party at the table has to suck it up. I would be perfectly willing to take less salary as a physician if I didn't have to go $200,000 in debt to become one. So we need to fix healthcare costs and I think we need to fix medical schooling costs (while still keeping high admissions standards). Thanks Aaron!