As Bob Laszewski points out today, the current Obama budget does little to actually reduce health care costs. But, as I pointed out last week, the only sacred cow yet to be gored is that of physician reimbursement.
Bob notes:
“The Obama budget did not tackle physician payment reform or call for any physician payment cuts but said, “The Administration believes that the current physician payment system, while it has served to limit spending to a degree, needs to be reformed to give physicians incentives to improve quality and efficiency. Thus, while the baseline reflects our best estimate of what the Congress has done in recent years, we are not suggesting that should be the future policy[emphasis added]. As part of health care reform, the Administration would support comprehensive, but fiscally responsible, reforms to the payment formula. ”
Last week I thought that this might have been intentional, noting “Is it possible that the absence of physician reimbursement cuts from the proposal is part of an overall strategy whereby everyone else complains about docs not doing their part? Is this a calculation on the part of the Administration, who recognizes that the physician lobby is the strongest it will have to contend with? Have they deliberately set up a physicians v. everyone else ‘discussion’?”
Before my physician friends start throwing electronic rocks at me, realize I am reporting, not advocating.
Mar
5
It’s probably a smart move on their part. The Drug and Insurance industry are easily villified. Physicians are the most trusted occupation in the US (Harris Poll). The strongest lobby is one answer because it’s not just the AMA its AARP as well that will act if any cuts are proposed. Cutting Reimbursement will cause physicians to limit new Medicare patients. Not the thing seniors want to hear at this point. Enacting universal coverage while cutting reimbursement and limiting access to Medicare Beneficiaries is a surefire way to be sent home in 2010 or 2012 and cause reform to be DOA.
As long as physicians are paid to do procedures, surgeries and office visits on a fee for service basis, health care costs will not be controlled. Physicians need to be salaried, and they can be well paid – then the financial incentives are more in line with less resource utilization. Phone advice and e-mail advice would be more palatable as the docs will not make you come into their office for a billable visit. Procedures will be more carefully assessed for appropriateness. Right now, the path of least resistance is do everything I know to do and the referring physician is happy, the patient and family are happy and I get paid for it. But health care spending just keeps going up. I have no idea how hospitals would be reimbursed –since they are paid by having their beds full. Is anyone talking about this?