Debate rises over whether Medicare pay cuts will hurt doctors’ practices, patients

[alp227]

Source: Wash. Post

The impact of mandatory Medicare pay cuts triggered by the congressional debt panel’s recent failure to reach a deal is the subject of sharp disagreement.

Doctors and hospital officials are warning that the cuts could have serious repercussions for American health care, prompting many doctors to drop Medicare patients and forcing hospitals to lay off staff and consolidate facilities.

But prominent health-care analysts — including those serving an independent agency charged with advising Congress on Medicare — suggest the problem is not that doctors will be short-changed, but that most will continue to be paid too much. And when it comes to hospitals, other experts contend the impending cuts are marginal enough to be easily absorbed and could even encourage more efficient care.

The “sequester” mandated by the law that created the debt panel in August will reduce federal spending by $1.2 trillion through automatic, across-the-board cuts to a vast swath of programs from 2013 to 2021. In contrast to the cuts to Defense and discretionary programs, those to Medicare will be capped at 2 percent per year. Seniors’ premiums and cost-sharing cannot be raised. Instead, the reductions will come out of Medicare’s payments to providers and managed care plans, for an estimated total cut of $123 billion through 2021.

Read more: http://www.washingtonpost.com/national/health-science/debate-rises-over-whether-medicare-pay-cuts-will-hurt-doctors-practices-patients/2011/12/02/gIQA6go4PO_singlePage.html

[madfloridian]

1. This paragraph is just ridiculous...of course it will do harm.

"But prominent health-care analysts — including those serving an independent agency charged with advising Congress on Medicare — suggest the problem is not that doctors will be short-changed, but that most will continue to be paid too much. And when it comes to hospitals, other experts contend the impending cuts are marginal enough to be easily absorbed and could even encourage more efficient care."

[IamK]

11. Many doctors are not taking new medicare patients...

expect the trend to accelerate as payments decrease....

not supposed to be a reply... woops

[MannyGoldstein]

2. Depends on the type of practice

I suspect that many specialties, such as cardiologists, will have to take whatever Medicare gives them. Want to run a cardiology practice that only takes folks under 65? Good luck with that - you'll lose 90% of your patients.

GPs on the other hand have plenty of under-65 patients, so they might choose to cut off Medicare patients. But GPs are relatively underpaid, anyway. So it might make sense to slash medicare reimbursements to cardiologists and so forth (who'll have to learn to scrape by on under $500k a year), and maintain reimbursement that allows GPs to keep making $150k a year.

[Mojorabbit]

3. My husband is a family practice doc

and this will make things very hard on us. We already see so many people for free. The payments are pretty low already. Family practice does not make the big bucks and we have pretty high overhead.

[MannyGoldstein]

10. I agree - by GPs, I meant FPs too.

GPs/FPs are not paid very much compared to other specialties. If statistics are right, I probably earn about as much as your husband (although I'm not a doc) and it sure doesn't seem like a lot of money - although we have to recognize that it's still a multiple of what the average American earns.

I have friends who are docs, and some earn fantastic amounts of money. Those folks should take a big hit, not your husband.

[Mojorabbit]

4. hiccup nt

[AtheistCrusader]

9. I've seen a sign at a urology specialty clinic saying 'after X date, no more medicare'.

Not seen any cardiology specialists.

[MannyGoldstein]

12. We'll see how long that sign stays up, particularly

since PSA tests are no longer being routinely recommended. Routine PSA tests have caused an enormous number of folks to be diagnosed (or misdiagnosed) with prostate cancer who should not have been, which gave urologists a ton of business. Hopefully things will start to dry up for that group (and hopefully we'll see fewer pointless prostatectomies!)

[No Elephants]

5. "Independent agency charged with advising Congress on Medicare" As if there were such a thing.

I guess it's easier to make across the board cuts that WILL hurt patients and legitimate doctors than to control fraud.

Also requires fewer government employees.

In reality, everything needs to be looked at, from what providers charge to the amounts Medicare will pay to those who abuse the system. But, again, that would take intelligence, bipartisanship, more federal action, actual thinking and work....

Ah, never mind.

[Sgent]

6. See

http://www.medpac.gov/

As for doctor's charges, they are meaningless in this context. The only time charges come into play is if they bill less than what medicare will pay. All doctor's I've ever worked with charge more than Medicare will pay. Medicare pays the LOWER of their allowed charge or the provider's charge. In my area Medicare already pays only 50-75% of private insurance.

The problem is the the Sustainable Growth Rate (SGR), which is the law unless congress changes it (they have every year for over a decade). There will be a 21.3% decrease in Medicare allowables if it doesn't change, meaning a 40-80% decrease in Medicare related income (depending on overhead of the practice).

If this happens all at once, most physicians I know -- at least those with the option to do so, will stop accepting outpatient Medicare patients.

[patrice]

8. Problem is that the problems aren't just about fraud. Like all software, the reporting systems

themselves can be made to process the same data in a variety of ways, legitimate in terms of the system, but the specific choices about how to report can have more to do with the needs of the business/institute processing the claim than the needs of the person receiving care. I'm wondering too if, like MS Project, you could even take certain outcomes and back them into the system, rather than accounting for care as it goes. There's a whole career field devoted to the flexibility of CMS reporting systems, persons called "Risk Managers". The general idea CAN be to make the institute look good so that other funding sources can be successfully pursued through development, which other funding, depending upon the specific type of grants and their accountability procedures, may or may not have that much effect upon direct care. All legal.

[Yo_Mama]

7. There is a scheduled cut of 27% in January.

Those cuts are in addition to this one.

[Islandlife]

13. Unbelievable article by the Washington Post

Who are they trying to deceive?

[Safetykitten]

14. But you see, these are not cuts. Just people not getting service. See? Simple.