Doc Fix: The Budget Gimmick That Actually Isn’t So Bad

Last year our medical office received 38% pay for our Medicaid patients, and those in the hospital we received 20% of our charges.

If our 11% approval rating congress heroically votes to decrease the reimbursement-no physician will be able to afford to care for these patients.

Doctors should not be the scapegoat of doc fix discussions. Currently, you need to spend as much time on the phone with an insurance agent to make sure your patient is covered for your recommended treatment as you do with your patient. This means that doctors need to hire more administrative staff to handle these phone calls. Because of the extra hoops docs have to jump through, they have increased overhead costs. The purpose of a doctor is to treat and handle their patients' every need. If doctors are wondering whether or not they can maintain a practice, pay their every increasing student loans, maintain the lifestyle they spent 6+ years in school to achieve, and worrying about whether or not their patients' treatments will be covered, how are they supposed to find the time to make sure their maintaining a good patient-physician relationship?

So what does it really mean to tie doctors' pay to 'quality measures'? Basically, reward the docs whose patients comply with as many of those ideal 'Healthy People' (the actual title of the National Center for Health Statistics' annual wish-upon-a-star collection of goal numbers) behaviors as possible, and punish the rest. Never mind that there's no way to compel such behaviors yet. (And, seriously, would YOU like to live in a country where judges could order people to stop smoking, start working out or lose a set amount of weight, or go to jail for contempt?) So how can docs reach those goals? By kicking those patients who don't comply to the curb, whether their failure is willful or not. Think 'The Biggest Loser' for the overweight masses, but with a potential death penalty. And a similar fate for those whose hypertension, diabetes or even asthma fail to show sufficient improvement. Is this the kind of society we want? If the answer is 'yes', then Walt Kelly's Pogo was right: "We have met the enemy, and he is us."

the idea of a one payer system is attractive and has become the battle cry of many..... however, the yearly doc fix spectacle is one of many warnings that we should heed before jumping out of the
private -insurance-pan into the single-payer-fire.

What other profession can survive with a flat rate for the last 10 years?

The switch in paying doctors for quality measures (like number of patients who quit smoking, or control their diabetes) instead of production (essentially number of patients per day) sounds like a good idea. However, those measures are largely focused on changes in nursing actions not changes in physician actions. The result is an incentive to hire more nurses to meet the Medicare/Medicaid requirements for a patient visit with only small changes in physician behavior. For example nurses, not physicians, will make sure each patient is up to date on vaccinations each visit. Just as we now have a cohort of billing staff to eal with increasing demands from Medicare and insurance, we will likely face promulgation of nursing positions to deal with quality measure demands. This does not seem likely to save money.

Deficit deniers: this is but a small wake up call.

Wait for bigger and better ones to come, around the time of the next election!

The biggest reduction in costs will come from drug sales and not doctor fees. And it is not because of pharmaceutical companies reducing costs. It is because insurance companies across the nation insisting on prior authorization of almost every expensive drug that a doctor prescribes. This forces them to choose cheaper ones or spend at least 90 minutes a day obtaining authorizations for patients. They are great many new and exciting drugs coming in the pipeline - I doubt if all Americans will ever get to benefit from them the way things are going!

Clinical efficient practice rules would solve a lot of these problems. The commission to do this is included in the ACA but fought by the repubs. 40% or more procedures are not indicated. Unnecessary procedures, drugs, operations are occurring each day. Billions of cost. Most not indicated when reviewed. We have lots of evidence about what, when and how to treat many diseases that is ignored.
The evidence is clear and it needs to be practiced. Don't expect the Docs to do this since it allows them to make millions. Cut in pay? Do more procedures, have more gadgets in the office to charge for.

Anti-deficit hawk Mr. Adler has reviewed every "doc fix bill" since the late 1990s. He reported that Republican (as well as Democrat) members of Congress voted to cut Medicare funding, mostly to hospitals, virtually every year.

Since Obamacare was passed, Republicans have accused Democrats of being the ones who cut Medicare funding. That was a reduction in the future rate of reimbursement to hospitals that hospitals (via their trade organization the American Hospital Association) agreed to because Obamacare would provide coverage to more Americans and reduce hospitals' uncompensated care. Not so with the doc fix bills. Those were reductions in Medicare payments to hospitals without offsets to make them whole.

So, who is responsible for more damaging cuts to Medicare funding - Republicans or Democrats?

To clarify, many of the offsetting cuts are for diagnostic services. Of course, that has the effect of reducing diagnostic services. Is that a real cut? It is if the foregone diagnostics are unnecessary, but not if the foregone diagnostics would have detected conditions that could have been treated early at much lower cost. That's the problem with health care in America: much of the spending is on diagnostic services, services that patients believe are essential, but the data indicate they are not. That's little consolation to the family of the man who didn't have the catheterization and who has a fatal heart attack.