The Balance Budget Act, passed in 1997 by Congress, adopted the SGR (Sustainable Growth Rate), which aimed to control federal healthcare spending. Basically, the SGR formula aims to keep the total increase in Medicare reimbursements to physicians from exceeding the change in GDP (Gross Domestic Product).
However, since its inception, the cost of reimbursing health care services rose faster than the increase in GDP. In order to prevent Medicare recipients from going without care, Congress has fallen into the convention of passing temporary short term fixes to the SGR formula. In fact, Congress passed 17 such stopgap fixes since the onset of this legislation.
On March 26, 2015, the House passed the HR2/SGR Repeal bill that would repeal the SGR formula by a substantial majority. Many proclaim this as a rare bipartisan victory. As the vote was set to go to Senate, they decided to delay it until after a 2 week recess. And rather than cut doctors reimbursement during the 2 week recess as went into effect April 1st by failing to issue a fix, doctors payments will be delayed until the Senate returns and votes. Plainly, we are expected to keep working, while the Senate enjoys their spring break, and not expect to get paid anything in this period.
Many people look at this bill and see that it will repeal the ill-fated SGR formula and throw their support behind it. But, this bill consists of 250 pages, all written in legal language. People miss many of the other actions hidden in this Trojan Horse bill. And when reviewed in totality, its impact on the future of healthcare is quite adverse.
One of the measures of this bill would be to turn away from traditional fee-for-service payments to providers and move to outcome based ones. For example, as a physician, I would get paid depending on whether a patient chose to heed my advice as well as the care I provide. Yet, the full burden falls on me as the provider of the service. The patient bears no responsibility for choosing unhealthy lifestyle choices.
While the proponents proclaim that this will lead to improved clinical outcomes, they are blinded to the whole picture.
Doctors cannot afford to practice uncompensated. Overhead costs soar and our salaries have remained stagnant for the past decade. What will likely happen is that doctors will deselect the more non-compliant and complex patients. Additionally, many doctors will opt out of Medicare completely.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Where will those Medicare patients receive care? And that population is growing daily. It is estimated that in the US, approximately 8,000 people turn 65 years old every day.
The government should be ensuring healthcare for our nation’s elderly and not driving doctors out of business and forcing others to opt out. Doctors should be reimbursed for the extra work we give these patients, many of whom have very many medical problems and will have poor outcome no matter what we do to help them.
The HR2 bill also codifies the Meaningful Use (MU) Program into law. Doctors for the past few years have objected to the enforcement of this program. One of the main reasons is that the technology that is required to meet these requirements does not exist yet. And the metrics reporting is tearing time away from our face time with patients.
Just yesterday, I heard 2 patients talking in the hospital saying how doctors only care about their computers these days.
MU is destroying the very sacred fabric of the doctor-patient relationship. MU should not be used to penalize doctors’ reimbursements until it has been made functional. It is outlandish to put into federal law a system so flawed that it cannot do what it is supposed to do at this post. Did any of the House members try to enter metrics into an EHR? Did any of them even talk to a physician who is doing this to see how unreasonable it is?
Amidst the vast sea of the HR2 bill, MOC (maintenance of certification) also becomes law.
For months, doctors have been crying out in the media the corruption of the leaders of this process and how no evidence exists to support its effectiveness. The leaders of the medical boards are making obscene profits despite the protests of its members. How can you pass into law a proposal that more than 90% of practicing doctors disagree with? Many doctors have changed their careers paths to retire early rather than continue the forced mandate of doing something they disagree with. This will precipitate an already growing physician shortage.
While the idea of repealing the SGR formula seems noble and many are excited to finally see a permanent fix, this bill sets up bigger problems down the road. Doctors fight many outside forces trying to interfere with the practice of medicine. A bill passed by the Senate should not be another one. Do we really want doctors forced into political battles or would we rather support them to give the best care and attention to their patients in the exam room?
[Photo from Wikimedia Commons]
