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Title : Physician Payment Reform--Time For Difficult Choices

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Physician Payment Reform--Time For Difficult Choices

I of late authored a invitee editorial inwards the Feb 15th edition of Family Practice News--"The Leading Independent Newspaper for Family Physicians."

Many years ago, the Congress established the Sustainable Growth Rate Formula (SGR) to command physician spending inwards Medicare. The concept is simple, if Medicare physician costs grow at a stride beyond affordability, side yesteryear side year's payments larn cutting to rebalance spending getting us dorsum on an affordable track.

Of course, nosotros right away know that Medicare's physician costs convey risen faster than the sustainable grade as well as the Congress has overridden the formula every year. Private payments to doctors oftentimes tied to Medicare schedules convey risen inwards tandem.

Now the docs are headed for a 21% fee cutting on Jan 1 driven yesteryear the SGR if the Congress in ane lawsuit to a greater extent than doesn't act. Will they merely punt again--likely cutting Medicare HMOs to pay the docs--or volition they live on human face to physician payment reform?

Today, everyone says ditch the SGR because it's a disaster as well as hasn't controlled anything. But hold off a minute, isn't the SGR merely the parakeet inwards the mineshaft?

Pay for functioning (P4P) seems to live the solution d'jour. But it won't operate to command costs unless the overall physician community ends upwardly getting less than it would have. P4P proposals without teeth are merely a political sham to pay everyone more.

Here is my editorial:

Time for Hard Choices

When it comes to wellness attention reform, ane affair no ane argues close is that costs volition remove to live cut. If President Barack Obama as well as Congress desire to insure to a greater extent than people, the coin volition convey to live spent to a greater extent than efficiently.

Unfortunately, however, cutting costs, specially physician payments, is going to live extremely difficult—if non impossible—to do. I convey been watching the political debate amidst physician groups inwards Washington, as well as I've also been out inwards the ease of the the world talking to physicians as well as physician groups. I convey come upwardly away amongst the clear impression that none of them believes he or she tin live paid less. All of them believe that their backs are against the wall, as well as that they merely can't remain inwards draw organisation nether the electrical flow reimbursement system. Where does that travel out us? I don't know.

Pay for functioning (P4P) is ane sentiment that has been touted every bit a partial solution to our wellness attention toll problem. It sounds similar a swell idea; who tin debate that nosotros should non live paying for practiced performance? The occupation amongst it is that there's an elephant inwards the room: If yous inwards fact pay for functioning as well as pay to a greater extent than for the people who are the most efficient, yous volition pay less to doctors inwards general. P4P is a agency to pay less. It has to live a agency to pay less, because the Medicare program—which is currently experimenting amongst P4P—is headed toward insolvency inwards a few years. But inwards the P4P systems I see, it looks similar everyone's a winner. Real P4P isn't going to operate that way.

Another sentiment existence suggested for changing the wellness attention toll construction is revising the Sustainable Growth Rate (SGR) formula that is used yesteryear Medicare to calculate physician payments. But here's a inquiry yous don't remove heed inwards Washington: What's incorrect amongst the SGR? It was created close 10 years agone to automatically peel dorsum physician payments when the aggregate payments were unaffordable. Is it non the parakeet inwards the mine shaft alarm us close spending likewise much?

I'm non proverb that the SGR is perfect. But isn't it the SGR's chore to enjoin us when the organisation is broken? If so, delight don't shoot the messenger.

The SGR is a practiced representative of existent toll containment. Maybe Medicare got the formula incorrect inwards damage of payments to original attention physicians vs. specialists, but inwards the aggregate, what's incorrect amongst the response it's giving us? Congress says nosotros convey to rebase it, which agency “Never mind, let's laissez passer on the doctors what they want.”

The SGR could live tied to a benchmark nosotros could afford, such every bit the increment of the economy. If that benchmark were sufficient, nosotros would live on rail to payment reform. I don't desire to defend the SGR inwards detail, but tying it to a benchmark of sustainability seems similar a reasonable affair to do.

All this soundless leaves opened upwardly the inquiry of how much waste materials at that topographic point is inwards wellness attention spending. Data from the Dartmouth Institute for Health Policy as well as Clinical Practice demonstrate that 30% of all wellness attention dollars are spent wastefully. We know how to laid upwardly that, but nosotros don't desire to create what nosotros know needs to live done. Part of the solution is given inwards the Obama wellness plan—deciding which procedures as well as treatments are appropriate inwards which circumstances. Influenza A virus subtype H5N1 federal toll board that oversees when certainly procedures are used would larn a long way toward eliminating the waste. But that would larn a lot of opposition from the device manufacture as well as other wellness attention lobbying groups.

Health attention reform isn't going to live easy; it involves a lot of hard choices. But nosotros remove to convey the courage to create what must live done.

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