What Do We Have To Lose?

As the year ended, Senator Nelson of Nebraska became the 60th vote to advance the senate’s version of healthcare reform. In return, we, the taxpayers, have the privilege of paying 100% of the increase in Medicaid costs for Nebraska in perpetuity! That is only one of the numerous egregious side deals cut to advance this legislation.

I have been tracking the healthcare debate in the Wall Street Journal on a daily basis. They seem to be the most timely and insightful in their analysis of the various bills. Over the holidays, Scott Gottlieb, an internist and resident fellow of the American Enterprise Institute, wrote and excellent piece called “What Doctors and Patients Have to Lose Under ObamaCare.” He emphasizes the provisions of the bill that give CMS the power to specify which devices physicians use when treating a patient. This will affect orthopedic and neurosurgeons the most because they use the most expensive implants. If Congress believes that CMS has overreached, it will need to pass a bill to rein it in. This is exactly the opposite of the relationship between the other regulatory bodies of the government and Congress. They are only allowed to exercise power that Congress has given them. This is an unlimited power granted to CMS, intended to penalize doctors for their decisions on high cost implants.

Even primary care doctors will be held accountable for their referring doctors’ usage of resources. If care of their patients puts them in the top 10% of cost, the primary care physician will see his Medicare reimbursement decrease by 5%. This will create some interesting discussions between physicians over care of patients.

The most disturbing part of Dr. Gottlieb’s article is his description of the government’s intent to consolidate physician practices. The reform bill imposes new administrative costs on solo physician practices such as requiring 3 years of medical records every time a doctor orders a wheelchair! On the carrot side, the government will share medical cost savings with physicians but only if the physician is in a group serving more than 5,000 Medicare patients.

These are initially demonstration projects but CMS has new authority to roll out these projects without Congressional approval. The demonstration project initiated earlier this year pays “providers” a global fee for an episode of care. The “provider” is, of course, the hospital, which then decides how much each physician receives. One of our partners in Dayton said he would rather own the hospital that decides his compensation than work for one that makes this decision.

We were warned that “change” is coming. We are at a critical juncture in our national life and the life of our industry. Please make your voice heard this month so that our representatives know our thoughts on their proposed legislation. It may be the last time we have an opportunity to weigh in for several years.
 

Thomas Mallon, CEO
Regent Surgical Health
P. 708.686.1522
F. 708.492.0547