At a time when Republicans and Democrats, House and Senate, can't seem to agree on anything, Medicare physician payment reform is the exception to the rule.  Recently, the House Ways and Means and Senate Finance committees reported out nearly identical bills to repeal the Medicare SGR formula and begin to move Medicare more rapidly toward paying physicians based on quality improvement activities -- the closest Congress has ever gotten to ...

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As a pain physician, I would like to personally explain to President Barack Obama, Kathleen Sebelius, senior citizens and any disabled American suffering in pain, the devastating effects that will result from the drastic Medicare cuts in chronic pain care that are scheduled to take effect January 1, 2014.  These cuts will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and ...

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If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications. Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A trust fund is projected to have insufficient funds to cover ...

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Is Obamacare even partly responsible for the slowdown in health care costs? That is silly. First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different. Does the law have some limited cost containment features in it? Yes. But these are either pilot projects or are years from being fully implemented. I have heard the ...

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Imagine you, like most traditional medical students, went to college for four years to earn an undergraduate degree. Like many, you might also have obtained a graduate degree or worked for a period of time. You then spend time and money fulfilling extracurricular activities, taking the Medical College Admission Test (MCAT), applying to schools and traveling for interviews. If you are part of the lucky minority -- roughly 40 percent ...

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My dear Medicare patients: The government has just screwed you.  Did you know it?  Probably not, probably you have no idea about what the government is proposing to do.  But it is going to have profound effects on the quality of the care you are about to receive.  You are confused? You are surprised?  Let me explain. The government is proposing to change the way it pays doctors for outpatients visits. According ...

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AMA: Repeal the flawed Medicare payment formulaA guest column by the American Medical Association, exclusive to KevinMD.com. Last week’s release of the final 2014 Medicare payment rule serves as an urgent reminder to Congress that there are just 28 days before physicians who care for Medicare patients will face a steep 24 percent cut caused by the short-sighted, fatally flawed Medicare payment formula -- the SGR. Year after year ...

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Recently I was asked to intervene on behalf of a patient who, trapped by circumstance, was paying off an enormous bill for a lithotripsy procedure. What I uncovered wasn’t news, but it drove home how egregious the current system can be, why it so badly needs to be fixed, and how the Affordable Care Act (ACA) helps move us in the right direction. The patient had health insurance through her husband’s ...

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The sustainable growth rate (SGR) formula was enacted into law in 1997 to tie Medicare payment for services to physicians to the overall status of the economy. Basically, if the U.S. gross domestic product (GDP) does well, doctors get more money, and if it does poorly, doctors get less money for the same service. A decade of tinkering with legislation for circumventing the application of the SGR formula, preferably a ...

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In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients. Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% ...

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