Texas Medical Association Video: Grandma and the Big Bad SGR
I haven’t written much about the impending 29% Medicare physician payment cut. This threatened cut has happened every year for the past 10 years. Every year at the last second, Washington is convinced that if cuts take place, physicians really will stop seeing Medicare patients and they halt the cut.
It’s not a bluff. Physicians can’t afford to see Medicare patients, TriCare (ex-military) patients and disabled patients with Medicare benefits now, and they will drop out by the tens of thousands if they get paid any less. Any businessperson worth their salt will tell you that when revenue does not exceed expenses, you do not have a sustainable business model. Physician have cut expenses to the bone, taken deep cuts in their salaries and ultimately have sold their practices when they just can’t make it anymore.
But never mind the doctor, what about the patients? What happens to them when physicians stop seeing Medicare patients? Texas Medical Association has made an outstanding video that explains it in language we can all understand.
Other organizations that are working to eliminate physician reimbursement being tied to the SGR are MGMA and the AMA.
Posted in: Headlines, Medicare & Reimbursement
Leave a Comment (3) ↓
Dear Mr. President
I sense that you are struggling with managing the budget and its seems that you and the MEDPAC committee are having trouble finding ways to save money and increase the value to the system of providing medical care. I have good news . It’s really not all that difficult and it can be done without cutting the throat of Doctors who are underpaid for their services by Medicare currently.
For many years now many healthcare providers have taken advantage of a loophole in the payment rules and allowed hospitals to bill for their services. These services are identical to services provided by other physicians except that they are reimbursed at rates varying from 20-150% or more than identical services provided to Medicare beneficiaries. Apparently a long time ago, someone convinced the government that services provided in a hospital based clinic were worth more than services provided by private practice physicians and considerations such as regulatory compliance should be an allowable expense to the Medicare system. I personally think this is hogwash and we should have one fee schedule for all physicians. If I have done the math properly, a few hundred billion a year are spent on physician services and if 50% of the physicians in this country now work for hospitals then stopping this horrible overpayment will result in savings of tens of billions of dollars each year and will be more than enough to plug the SGR gap without cutting rates for physicians who more than earn their money.
I will admit to being a simple country Doctor and high finance isn’t my forte but I believe this would help fix one of the looming problems in medicine. I am a simple man and I like simple solutions. Another problem with the current Medicare system is the gaming of the observation vs 1 day admission rules. The current system encourages hospitals to over document and stretch the rules that are used to review one day admissions. Outliers on the high end of costs compose about 3% of claims at some hospitals but approximately 12-18% of admission in hospitals are single day admissions. This low end anomaly costs the Medicare system hundreds of billions of dollars of costs each year. The RAC system seems to be having a major impact recovering these overpayments. Since I’m a simple guy , I would propose that we pay all hospitalizations under Medicare and Medicaid at observation rates if they last less than 48 hours. The savings will be large and immediate and again in the billions of dollars range.
A similar problem is patients who are readmitted within 30 days. Eliminate the first day charge differentials for all these admissions and require a comprehensive plan for avoiding these admissions at all at each facility providing acute cae hospital services to patients. The personnel who are charged with gaming the observation rules can be refocused on managing patients for a revenue neutral proposal for the hospitals. Again the savings would amount to hundreds of millions of dollars since 20-30% of Medicare beneficiaries admitted to the hospital are readmitted within 30 days. A more reasonable rate of 10% should be easily achievable and create large savings for the Medicare program.
As I suggested, it’s not all that hard to create savings for services that are overcompensated and continuing to pay other physicians at fairer rates. I might point out that we have studied and have established that Medical homes provide higher quality and better valued services to Medicare beneficiaries than non medical home practices. Perhaps rather than experimenting with someone’s pipedreams, we should establish criteria for being a medical home and establish a fee schedule with savings from the above suggestions to fund this change and create more savings for the Medicare system. I’m not against experiments but perhaps we should go with tried and proven rather than follow the drug induced whims of policy wonks who have no clue about how to fix the problems in Medicine. Mr. President I hope my suggestions are helpful to you and lead you to better solutions that some of the Alice in Wonderland suggestions that have been provided by other advisors to you.
Lastly, I’d like to point out that Medicare as it has been modified and added to is a failed system. We need to reexamine the system in terms of current research and alter the program to correct design flaws to prevent costs of not being able to afford quality primary care services. Instead of a confusing 20% after meeting a deductible after allowable charges scheme, perhaps we should adopt the Federal employees and Medicare Advantage model and move to a no deductable co pay system so patients know how much they owe and offices can easily explain the charges and owed amounts to the patient. By increasing access to quality primary care we should eb able to manage conditions and avoid unnecessary costs to the system such as ED visits and emergency admissions for UTI’s and problems that can be easily managed as an outpatient. This increase in quality primary care costs should lead to a decrease in avoidable medical procedures such as cardiac services and cancer care that are largely avoidable or have the ability to be much less than current incidence rates of these conditions. I realize that we will never eliminate all problems but correcting design problems in our current system would go a long way to fixing the problems. I hope my suggestions have been useful to you. They are a result of a medical career spanning 26 years in a rural area that have exposed me to a number of experiences that have shaped my thoughts. If I can ever help you or provide further information on my thoughts to you, please feel free to contact me.
Sincerely yours
Kerry A Willis MD
PS I’m still waiting to hear from you
Discussed on Linkin but I’m not sure what folks really understand about the problem. Our leaders need to suggest answers as well as raise the problem…Here’s mine. I care not who solves the problem but the problem needs addressing.
I find that almost all Physicians offices are in a state of uncertainty about the future and are dragging their feet on making decisions and plans for the future because OF THE MEDICAL AND ECONOMIC UNCERTAINTY. The problems causing our current economic problems in the country in general are related to the same lack of solutions for economic problems and uncertainty in general.
While there is undoubtedly a problem with the reimbursement formula and healthcare costs in general, that video was absolutely terrible, had a few false statements, and did not effectively convey they message that needs to get across and will most certainly not attract the attention of anyone that can actually do something about it.
@Kerry Willis, you are directing your open letter, as most people that don’t understand politics, at the wrong person. The first mistake (and the only one I’ll point out at the moment) you made was directing it toward the President. He can suggest legislation, but not introduce it. Try talking to the useless swill that occupy Congress.