Yesterday the Senate passed a bill extending unemployment and other benefits and subsidies for another month; one of the less well known provisions prevented imposition of a 21% cut in Meducare physician reimbursement.

'Prevented' isn't exactly correct; the bill merely delayed implementation of the cuts till the end of March.

For years Congress has avoided implementing Medicare reimbursement decreases, bowing to intense lobbying by physian groups and other parties outraged at the very idea that their income will be reduced. I can't really blame the docs; as I've reported here in the past physician income, especially generalist physician income, has not kept pace with inflation for several years.

What I'm less impressed with is the failure of physician advocacy groups to offer a reasonable alternative to the present fee-for-service system. Anyone with a clue acknowledges that FFS is one of the biggest problems in our health care system, rewarding providers for doing things to patients and not for keeping them healthy.

At some point we have to - must - adopt reimbursement methodologies that reward results not activity.

Don't expect this to happen before the end of March. No, we're much more likely to see the Senate boot this can once again, and with it the chance to fix a fundamental problem with our health care system.