If your boss threatened to slash your pay by 21 percent, then said ‘never mind,’ then threatened again, then changed his mind, then threatened again, and kept this up for eight years…
You’d be ready to tell him to take this job and shove it.
That’s how Congress has been dealing with doctors who treat Medicare patients. And lo and behold, a lot of doctors are walking away from Medicare.
The shorthand for this Congress-created mess is “the doc fix.”
Doctors who treat Medicare patients are paid fees according to a complicated formula created by Congress. The formula sets limits on Medicare’s overall spending for physician services. If that limit is exceeded, a fee cut kicks in.
In 2002, the formula dictated that doctors’ fees be cut. The docs screamed. The politicians caved and temporarily suspended the formula. The doctors got a reprieve from the pay cuts.
And thus the “fix” was born.
Congress has routinely suspended the pay cuts dictated by the Medicare formula. The suspensions are temporary, because members of Congress don’t want to admit that they’re walking away from health care cost controls. But the suspensions keep coming.
In June, lawmakers did it again: Suspended the pay cuts through the end of November. (Cost to the federal budget: About $6 billion. Doctors will face cuts of around 23 percent in December if Congress doesn’t back down again.
Enough. This is a cost containment charade. Medicare already pays less for services than many private insurers pay. One family practice doctor in Chicago’s western suburbs told us Medicare pays $56 for a basic office visit that may last up to 15 minutes. Blue Cross pays $65 for the same visit, Cigna pays $75 and the sticker price is $95 for uninsured patients.
Now factor in the threat of deep cuts. No wonder some physicians refuse to accept new Medicare patients or, in rarer cases, have dropped all Medicare patients. In Illinois,18 percent of doctors in an American Medical Association survey said they restrict the number of Medicare patients they treat. The figures are similar nationwide. Lawmakers need to fix the doc fix … or watch more physicians walk away from Medicare.
So here’s our prescription: Scrap the broken formula. Create one that pays doctors to provide high quality, efficient care, not just to provide more care. For instance, reward doctors who eliminate unnecessary tests and treatments.
This argument has been overshadowed lately by President Barack Obama’s controversial decision to install Dr. Donald Berwick in charge of the federal Centers for Medicare and Medicaid Services through a recess appointment. It was a bad idea to bypass Congress. Republicans say Berwick is an advocate of government rationing of health care and point to praise he has offered for Britain’s government-run health system. The recess appointment, and other controversial statements by Berwick, have created more suspicion.
But Berwick has been an advocate for innovations in efficient, patient-centered care, such as the use of electronic medical records, which give patients and doctors faster and more reliable access to health information. Let’s see what he can do in this daunting position.
Job One for Berwick: Overhaul Medicare’s antiquated model. Fix the doc fix. Reward doctors for excellence and efficiency.
