Physicians Will Have to Wait for Now

Congress has adjourned for the year without passing a final budget bill for Medicare in 2012. Both houses, however, are likely to vote  for a reconciliation bill to be passed in the next session, sometime early next year. The focus on the Medicare bill has been on a proposed 4.4% cut in physician fees. The cuts have been rescinded, although fees will stay static. This has to be recognized as a cut of sorts, since fees have not kept up with inflation (and medical inflation consistently surpasses that of the economy as a whole). What is truly important in the reconciliation bill, however, is that so-called “pay for reporting” provisions, set to start in 2013, were also taken out.

Under “pay for reporting”, physicians not reporting certain metrics to the Center for Medicare and Medicaid Services (CMS) were to be penalized by having their fees cut by 2%. CMS has envisioned “pay for reporting” as the start of “pay for performance” programs, where physicians would be judged on certain metrics and paid accordingly. A sort of “no child left behind” plan for medicine, those practices in poorer areas would clearly lose out, as would small practices not able to afford the technology needed to report metrics to CMS and insurance companies.

Certain parts of organized medicine, most notably the AMA, have come out against “pay for performance, whereas the American College of Physicians (ACP), a lefter leaning group representing internists, has supported the concept. And despite my progressive leanings, I have many misgivings about “pay for performance”. Better to focus on universal coverage and greater access to care than on arbitrary, artificial metrics. And if the powers that be keep trying to look for ways to pay primary care providers less, and not more, fewer physicians will bother to go into the field, resulting in lower pools of applicants applying to physician jobs, resulting in less talented physicians in the field! This will be a detriment to all of us.

A review on current management of myocardial infarctions and acute coronary syndromes by Eugene Braunwald ( probably the leading cardiologist in the U.S.) talks of the need to have all hospitals equipped with facilities to perform angioplasties. Great. Primary care, which if done properly, would decrease the need for such expensive facilities. But you can guess where primary care is heading. We all seem to be more interested in the glitz and less on getting the biggest bang for our buck. But with health care GDP at 16% and rising, we need to take a step back on concentrate on health care basics.