by Glenn Laffel, MD, PhD
Max Baucus’ decision to release his solo album—subtitled the Senate Finance Committee’s proposal on health reform—was timed with the precision of a 4th grade marching band.
Physicians could live with that, but the bill contained gornisht on tort reform and not much more than that on Medicare reimbursement. Upon seeing that, the Long White Coats reacted as if they’d seen earwax on their stethoscopes.
“The feeling of most doctors is that what’s being proposed is not adequate,” Peter Levine, president of the Medical Society of the District of Columbia understated to the Washington Post.
Some docs even grumbled that the Montana Democrat swept aside tort reform after receiving a pep talk from Senate Majority Leader Harry Reid, a lawyer that has secured a million dollars plus in campaign contributions from lawyers and law firms already this year.
Of course this was just insult added to the injury caused by Obama’s airy drift over the subject of tort reform during his speech before Congress 2 weeks ago.
The Long Whites have legitimate reasons to feel abandoned by the Big O, Baucus and the Dems. They had after all, voted for Obama in droves, and the AMA—which had reflexively opposed every single government effort to remake health care from Medicare to HillaryCare—came out bright and early in support of Obama’s reform plans, including the public option.
Obama reacted to the lounge chatter by announcing he would accelerate his program to sponsor state-level experimentation with tort reform, the one he first announced during the “You Lie!” speech.
The plan sets aside $25 million, to be allocated by HHS in the form of $3 million competitive grants, to help states and care systems test models that emphasize patient safety, reduce preventable injuries, foster improved communication between doctors and patients, ensure that patients are compensated in a fair and timely manner for medical injuries, and so on.
Grant allocation would be driven by the results of a “review of what works,” which is supposed to be completed by December.
And that’s it.
That is not going to cut it for the Long Whites, as BNet Health’s Ken Terry points out. Twenty-five mil is a ridiculously small amount of money for federal demonstration projects to begin with, and the underfunding problem will be complicated by competing objectives for the project: improving patient safety and developing new tort reform strategies.
Plus, the low top-end on grants, $3 million, means cash-strapped states will have to supplement the demos, which could sink the boats before they are christened.
Reaction from providers was swift and predictable. After describing the Big O’s plan as “smoke and mirrors,” Levine added this: “It’s all incredibly disingenuous…the president got up and gave a speech to the nation and said we need action now. But when it comes to medical liability reform and tort reform, it needs to be studied. The whole concept is so hypocritical.”
Maybe so, but credit Obama for understanding that the Feds can’t implement tort reform all by themselves, so long as states maintain jurisdiction in malpractice litigation and set insurance premiums.
If we’re ever going to get the tort reform physicians so desperately want, Washington is going to have to work with the states, like it or not.
Glenn Laffel is Sr. VP, Clinical Affairs at Practice Fusion.
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The CBO just concluded that Med Mal Reform would save $54 Billion over ten years. It’s time for Drs. Rohack et al to get back in there and “Git ‘er done!”
$54 billion in liability reform savings is nothing. The only number that matters insofaras tort reform ins concerned is how much less money the trial lawyers would give members of the Democratic party if they DARED to pass anything that would infringe upon their little liability fiefdom.
So, we are going to let lobbyists arbitrarily decide the value of cases, and give up a constitutional right, in exchange for POSSIBLE savings of less than .5% in healthcare over a decade?
If that’s the road you want to go down, Doc99. But don’t be surprised if people wonder how much we could save if we started trimming doctor’s pay. I bet we could save 0.5% and doctor’s rights to be paid what they are aren’t constitutionally protected! You won’t have much ground to whine when people figure that out.
In response to Matt,
I love it when people throw out the idea of cutting physician pay with no grasp of economics. The truth is that the latest bill does assume a 25% pay cut to Medicare reimbursement rates to physicians.
Do I like this idea? Of course not. But this won’t hurt me nearly as much as it will hurt seniors. I stopped seeing Medicade patients long ago and would stop seeing Medicare patients if this were to happen because I would actually be losing money.
The real damage to reducing physician compensation is something all too familiar to those of us with parents in their 70s and 80s. Mine have been trying to find a primary care doctor for the last 2 years unsuccessfully. As far as I know all the physicians in their town are still doing fine financially, but my parents are the ones paying for the lousy compensation offered by Medicare.
*source for the proposed 25% Medicare payment reduction:
http://online.wsj.com/article/SB125501381237273575.html
From the article:
“The Finance Committee bill would postpone a big cut in Medicare payment fees to doctors that is scheduled to take effect in 2010, but then assumes the cut would take effect the following year and result in a 25% decrease in Medicare payments to doctors. The bill also sets Medicare payment rates for other health-care providers at rates below inflation.”
Matt … If the Slip n Falls won’t give to Dems, to whom will they, Republicans? Somehow, I don’t think so.
As for Medicare payment cuts, do the Dems truly want to drive docs out of Medicare?
I believe the reason the AMA signed on to the latest bill was that the cut was removed, or at least postponed.
99 why should anyone worry about driving docs out of Medicare? Where they going to go?
Nope, the 25% cuts to physicians were one of the many things that were included in the CBO’s most recent cost analysis that was just released last week. This resulted in their analysis showing that the new bill would reduce the deficit unlike the previous version that they found would add to the deficit.
The Wall Street Journal article cited by Frank was just published this past Friday. I have not heard any official AMA response, but I would imagine they would not be too thrilled with a 25% cut to physicians seeing medicare patients.
Matt … law school LOL.
Matt, I think what you fail to realize is that if doctors lose money on Medicare patients, they will not see them. If you’re a lawyer and you have a client who wants to pay you $10 per 15 minute consultation and your overhead for that amount of time is $20, what would you do? There are other patients out there. If there aren’t enough patients to fill in the extra time, take a pay cut, keep the practice open only four days a week and regain some sanity.
Honestly, I think it would be great if there were a Medicare cut of 25% because of the SGR. The whole deck of cards would come crashing down when all doctors refused to see Medicare patients. Medicare would have to start paying at sane rates and congress wouldn’t play a game of chicken every year with physicians and the AARP.
99, that was pretty funny.
But at the end of the day, where are physicians going to go? Where else are you going to find a job paying an average of $150K, and $250K for surgeons, in a recession, and still maintain your current lifestyles? (those averages come from the Dept. of Labor). Simply put, you won’t.
Now, maybe it will force you back into the market, but a lot of you would struggle to compete as the rest of us professionals do. You have to market your services, you have to figure out how to bill, and you have to collect from at times insolvent parties. How many physicians still know how to do that? I’m betting not many.
But maybe you can figure it out. I for one, hope so. But I don’t think your lobbyists are really working hard to push you back into the market. They’re looking to preserve their own clout by cutting deals within the existing system.
Matt, people like to throw out the fact that it is hard for physicians to switch careers, which is true. That does not mean that physicians will not respond as logical players in a market with regard to reimbursement. Yes a surgeon cannot easily decide to some other career, but he can decide what types of cases he does and what kind of call agreement he has with certain hospitals. A lot of surgeons for instance agree to take emergency call, which typically nets the physician barely anything since these patients often have no insurance, but the surgeon will write this off as a loss that is worthwhile since he can make up for this doing other procedures and seeing his clinic patients throughout the week.
Now take away the profitable operating days from his schedule. Do you think he is going to be able to afford to take emergency call in the hospital. The answer is no, and I have known physicians that have faced this very dilemma. The result that I have seen is surgeons will stop being one of the “general” surgeons in the town, and will switch to smaller, quicker, and less risky surgeries with less followup. These can often be done in an outpatient surgery center.
A hernia repair for instance lets a surgeon bill about 12 RVUs (~$1200) this translates into about $280 for the surgeon after overhead. If you gave up all hospital call and other difficult general surgery procedures and just did simple hernia repairs, say 10/wk with 2 days of clinic you would end up making $2800 after expenses for the hernias and $1000 per week from seeing say 20 clinic patients each clinic day ($25/pt). This translates to around $3800/wk which would be equivalent to $160,000/yr with 10 wks vacation. I have known surgeons that end up making the move to some variant of this schedule to give up the difficult general surgery lifestyle. So the end result is that yes medicare may have saved some money by reducing the reimbursement to this surgeons in this area, but the end result is one less general surgeon available to a town when patients need an operation in the middle of the night.
Problem with that is that it will work for a few, but with the govt. paying 50% of all healthcare dollars, only so many of you can. There are only so many non-Medicare patients to go around these days. The smart ones will follow your plan early, but if you all do it your salaries still get squeezed as you compete against each other.
The only solution will be for the AMA to further restrict the supply of physicians at that point. Although it’s possible the public, or lawmakers, may start taking a harder look at the available medical school slots and how they are chosen and expand the number.
Matt is killing me. The government wants to increase the public access to healthcare by providing insurance for all. Cutting physician reimbursement will only worsen the access problem for all of the newly insured individuals. Oh well, they can just go to the ER for their toenail fungus and knee pain. I’m sure the system will handle that with no trouble at all. Maybe we should send all the trial lawyers back to PA school so they can take care of the masses storming into the ER for their “free” health care.
“The government wants to increase the public access to healthcare by providing insurance for all.”
Insurance doesn’t equal access. Why is this so difficult to understand?
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