Unintended Consequences – Coming Soon
Stanley Feld M.D.,FACP,MACE
Physicians in practice work hard and have little time for political and legal trickery. They assume their leadership will look out for their interests while they take care of patients.
The problem is physicians do not have effective leadership explaining the difficulties practicing physicians have every day with the healthcare insurance industry, hospital administrators, the government and the threat of liability. Most physicians are caring professionals who are not looking to rip off anyone.
Physicians do expect reasonable compensation commensurate with their training, level of expertise and level of responsibility.
I recently presented a physician income survey to a group of corporate executives. The executives were astonished by the level of physician income relative to their level of responsibility.
The unanimous reaction of these corporate executives was the average physician’s income was that of a low mid level manager. It is true some practice specialties earn more but the average income of practicing physicians is not commensurate with their knowledge and responsibility.
At the time President Obama’s healthcare reform bill was in trouble, the President courted physician leadership (AMA). Medicare reimbursement is sometimes below the cost of service. Physicians do not realize it because most are poor business people. Most physicians accept the low reimbursement because they view it as their duty to take care of these patients.
A noted physician executive wrote to me and stated that physicians are being treated like indentured servants by the government and the healthcare insurance industry. I had the same perception.
I told a CEO of a large healthcare insurance consolidator that physician apathy to their treatment is a sleeping tiger. The tiger is going to awaken if the healthcare insurance industry, the government and the plaintiff attorneys keep kicking them.
His reply was they are betting physicians will not react and remain passive. Physicians keep accepting price cuts because they love taking care of patients. I believe physicians will wake up and realize who is ripping off the healthcare system. They will react soon. I believe patients will side with physicians and aid in the physician protest. The time is getting close.
The President of the AMA and the AMA ‘s board of trustees have supported President Obama’s healthcare reform bill all along. I was shocked because it is a terrible bill for the improvement of the healthcare system.
President Obama promised the AMA he would repair the defective Growth Rate formula (SGR aka as the Doctor Fix). Physicians knew as soon as Congress created the Sustainable Growth rate (SGR) formula that it would not work. The physician belief has been proven every year for nearly a decade.
The AMA’s support of President Obama’s healthcare reform bill has infuriated many practicing physicians. They have quit the AMA.
H.R. 3962 is not the perfect bill, and we will continue to advocate for changes," AMA President J. James Rohack, MD, said, "but it goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians.
I could not believe the AMA would trust congress or President Obama’s promise to postpone the 21.3% reimbursement cut.
President Obama has stated that the cuts will not go into effect and there will be a fix for physician reimbursement. The government needs to decrease its entitlement exposure.
The U.S. House of Representatives passed a separate bill H.R. 4851 and delayed the cut until October 1st. This was before President Obama’s healthcare reform bill was passed by both houses of Congress.
The suspension of the doctor fix had been removed from the healthcare reform bill so as not to be included in the CBO evaluation of the healthcare reform bill’s impact on the budget deficit. This represents another of President Obama’s tricks. What is going to happen to entitlement costs or physician reimbursement when Medicare and Medicaid expand?
Dr. Rohack (AMA President) again applauded President Obama for his great leadership when the bill passed. Three days later the Senate rejected the House of Representative’s “Doctor Fix.” The cut are now scheduled to go into effect on April 1.
“Congress failed to act yet again, and as a result, the 21.3 percent Medicare physician payment cut will take effect on April 1. Congress will adjourn for its two-week spring recess without taking action to stop these programs from expiring.”
Now that the bill has passed the games start all over again. Sen. Tom Coburn, R-Okla., said the “Doctor Fix” should not be considered emergency spending. Emergency spending would exempt the Doctor Fix from budgetary offsets. The “Doctor Fix” should not be a budgetary offset. It must be included in the cost of President Obama’s healthcare reform bill because it will increase the budget deficit.
This repeated game of brinksmanship is wreaking havoc with physician practices and is causing both physicians and patients to lose confidence in the Medicare program. It illustrates in stark terms why medicine can no longer support short-term “fixes” to a formula that we knew would not work at the time Congress created it.
If congress keeps kicking those tigers they are going to wake up. The government and the healthcare insurance industry will lose its work force. Patients will be forced to carry the burden of the cost of care. President Obama’s healthcare reform bill will not have provided affordable healthcare. It will get the government off the hook.
Congress must stop playing games with physicians and patients and do what they know must be done: Repeal the SGR formula once and for all.
President Obama is not stupid. He must decrease the increasing cost of government entitlements. He must do it while looking good and being the defender of the people.
His problem is as soon as everyone (consumers, employers, physicians and patients) wake up and become aware of what he is doing his game will be over.
Organized medicine, consumer groups, or employer groups are not defending their constituents.
The primary stakeholders in the healthcare system (consumers and physicians) will wake up to the unintended consequences. Only then will we see a dramatic fall in President Obama’s approval rating and repeal of this terrible bill.
It is a terrible because it does not attack the systemic problems in the healthcare system. The bill increases the systemic problems.
The primary stakeholders (physicians and consumers) must demand sensible effective change.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Joseph E. Gutierrez, M.D., F.A.C.S. • April 2, 2010
Very good analysis ! Thank you very much !
John H. • April 5, 2010
One of the issues that most people overlook is that many physician’s insurance contracts are tied into the Medicare fee schedule. For example, a doctor gets a contract with Big Medical Co. and the reimbursement is set at 100% of Medicare. This could potentially lead to nearly 20% cut in that physician’s practice across the board. For most solo or small groups (who provide much of the medical care in the US), this would effectively shut down their business and severely limit access to care across much of the US.
Could they increase volume? Doctors are already busy and they themselves are the rate limiting step in a practice – one can only see so many patients an hour.
Could they cut costs? Many physician practices have already made substantial cuts and are operating with minimal staff.
And if you have doctors shutting down their practices who is going to take care of the 34M soon to insured? Which smart college student is going to spend 10+years in training only to graduate with $300K in debt and pay $20K in malpractice per year?
We have a near perfect storm for a true medical crisis in the making – more insured, fewer and under qualified physicians, long wait times and bad outcomes.