Because that’s what it is going to ‘cost’ to replace the current Medicare physician reimbursement scheme with something else. And make no mistake, as Trudy Lieberman of the Columbia Journalism Review points out, most of the nation’s physicians are adamant about ‘fixing’ Medicare reimbursement.
The issue is the Medicare Sustainable Growth Rate (details here). The net is simple – if the SGR formula/process is eliminated, a quarter trillion dollars gets added to the deficit, because that’s the amount the formula/process says has been paid to docs over and above SGR ‘limits’.
Current Congressional protocol requires CBO to ‘score’ any and all health reform proposals; unsurprisingly the SGR ‘fix’ has not been included in any reform measure, because it will push the cost way, way over a trillion dollars.
Thus, thru legislative legerdemain, Congress is avoiding talking about and being held responsible for the real cost of reform.
As long as we have to ‘fix’ the SGR – and I’m not arguing that Part B (physician reimbursement) doesn’t badly need fixing, hows’ about we ‘trade’ SGR elimination for some real reform, like, say, bundled pricing for specific procedures/conditions? Like, maybe, a flat cost for treating an asthmatic patient over a year including facility and physician and lab and other costs?
Or, for those chronic patients with more than one condition, a formula that pays for all their care based on a multiplier indexed to the number, cost, and severity of their conditions?
Or a requirement that all physician bills from practices that don’t have all patients on a share-able electronic medical/health record are paid under a non-fixed SGR, while bills from practices using ‘certified’ EMR are paid under a new schema?
Pretty draconian, you say? Not as draconian as anteing up another quarter trillion bucks, I respond. Sure it will be hard and take some time and isn’t easy and all that other blather. It’s a huge knotty ugly problem, requiring some ugly solutions, and none of them are going to be perfect. But they will be a damn sight more perfect than what we have if we don’t get reform-with-cost-control done this time around – family health care costs above $30,000 within ten years.
It’s time we got more from stakeholders than just their agreement to not block reform. We need a good more arm-twisting and a lot less gentle cajoling.
What’s the net?
Watch to see how Congress and the President handle the SGR redo issue. Do they use SGR as a lever, or do the docs use it as a club?
Nov
11
Don’t always agree with you, Joseph, but you are “right on” in your assessment of the SGR, and the manner in which the Congress is using “legislative legerdemain” to deal with the SGR. Frankly, it’s dishonest to the core. And we do need to get on with other ways to reimburse docs even though it will be very tough and take a long time to accomplish. Kudos for advocating that we get started.
Agree with you, Joe, and here is another arrow in the docs’ quiver – they are coming down hard on the fact there is a shortage of primary care docs and “physician extenders” (code for advanced practice registered nurses and physician assistants) are not appropriate to care for patients without direct supervision. So, look for funding requests for physician education (the AMA would like to increase the supply of docs by 25%) and an outright campaign to shut down nurse practitioners and PA’s. Too bad – this category of providers do especially well with health care teaching and case management of chronic disease. By the way – who caused the shortage of primary care docs? Physicians themselves!
Joe, I love you and generally agree with you, but how do the bundled payments get distributed? Hospitals, Primary Care Physicians, Subspecialists, Radiologists, PT, OT, Mental Health… None of these healthcare providers work under the same umbrella, so who gets the annual payment to divvy up?
Fee for service can only be replaced if there is a drastic overhaul of how healthcare is delivered. Until then, we’ll have a variation on what we currently have.
NY – thanks for the note and apologies for delayed response. Agree that this will not be easy, but the bundling will require providers to figure out how to work together clinically, operationally, and financially.
We MUST get rid of fee for service if we are to control health care spending and increase quality.
Here’s a piece that describes one approach, and notes the difficulty inherent.
http://www.fiercehealthcare.com/press-releases/trimming-u-s-health-care-spending-will-require-new-approaches-designing-adopting-stra?utm_medium=nl&utm_source=internal
Paduda
NY – thanks for the note and apologies for delayed response. Agree that this will not be easy, but the bundling will require providers to figure out how to work together clinically, operationally, and financially.
We MUST get rid of fee for service if we are to control health care spending and increase quality.
Here’s a piece that describes one approach, and notes the difficulty inherent.
http://www.fiercehealthcare.com/press-releases/trimming-u-s-health-care-spending-will-require-new-approaches-designing-adopting-stra?utm_medium=nl&utm_source=internal
Paduda