For those of you who have been following the Medicare travesty closely, and that certainly includes most doctors, you’re aware that the government has been dangling the threat of an across-the-board 21% decrease in Medicare reimbursements for a couple of years. Just as it is about to take effect, some emergency bill is passed to delay it for a few months so that they can do it again. This time the reduction took effect for a few days, so the Centers for Medicare & Medicaid Services will have to recalculate and send corrected payments, resulting in even higher administrative costs.

There have been a few defections by doctors due to this bureaucratic Chinese water torture, but nothing widespread—yet. Go on the physician forums and your can see that the ire is intensifying. We’ve calculated in our group that with the high percentage of Medicare patients and the fixed overhead, such draconian cuts, on top of recent reductions in payment, could reduce salaries by as much as 40%.

In the setting of all this, a study in the New York Times as reported in a recent issue of the ACC News Digest, reports, “When Congress aims to reduce Medicare spending, lawmakers often rely on cutting the prices they pay doctors and hospitals;” yet, “a new study shows how that approach may have limited success, if doctors respond by simply treating more patients to make up for the lost income.” In fact, the study “being published Thursday on the Web site of the academic journal Health Affairs, suggests that any significant changes in medical payment rates must be done carefully, said Joseph P. Newhouse, a health policy professor at Harvard who is one of the study’s authors.” In addition, the researchers found that “doctors frequently switched to more expensive options, like increasing their reliance on drugs like docetaxel, where doctors were paid roughly $2,500 for giving a standard monthly amount.”

Medicine is a calling, but it’s also a business. And as unrealistic cuts are implemented, it can be assumed that practices will try to evolve to offset fixed costs to survive. This is a more acute example of the economic “practice drift” I’ve alluded to in the past.

I’ve maintained that we physicians have to get our house in order. But the government’s use of a bludgeon to deal with a problem that needs a scalpel is typical in a bureaucracy that is addicted to spending and increasingly afflicted with a propagating virus known as corruption. Some analysts see this as intentional, an aggressive move toward socialized medicine, and that may indeed be the case, but doesn’t invalidate the preceding assertion.

The American people need to clean house too. It’s time we replaced the old guard with some fresh citizen-politicians not tainted by the inside-the-beltway culture, regardless of what side of the aisle we’re on.

To put it in the vernacular: “Throw the bums out.”


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