With the elections finally over, the United States Congress will be turning its attention to the lame duck session. Arguably one of the biggest issues facing the Congress is question of what to do about the Medicare “doc fix”. This topic has been written about time and time again because the issue keeps coming up time and time again.
Physicians who participate in Medicare – which is pretty much all of them – have been living with the possibility of having their reimbursement cut for years, but Congress has swooped in at the 11th hour every year since 2002 to make sure the cuts don’t happen. Well, delaying the inevitable has only made the cost of paying physicians skyrocket. What was once a molehill has turned into a mountain where Sherpas are needed to reach the summit.
The passage of health care delayed the cuts to physician pay, but only until December 1 when they will be dealt a 23 percent cut in pay and then another 1.9 percent a month later. All told, physicians are going to have quarter of the reimbursement under Medicare taken away from them. Talk about pushing doctors off a funding cliff. By the way, the cost to prevent the cut for 13 months – which will be added to the deficit – is around $15 billion.
Presumably, the 13 month cushion will give Congress enough time to finally scrap the formula that calculates physician reimbursement and come up with a new one. By the way again, that cost will add well over $200 billion to the deficit.
Here are a couple of things to consider. First, the Republican takeover of the House and the gains made in the Senate were based partially, if not wholly, on the American people’s anger against deficit spending. Reconciling this sentiment with the need for physicians to continue treating Medicare patients is going to very difficult for the Republicans. Second, doctors are fed up with being treated as a political football every time this issue comes up. They are forced into a system that rewards quantity of service, not quality.
Richard Hannon had a great guest column on Monday in the Wall Street Journal about the death of the family doctor and Medicare’s contribution to that death. He writes:
The primary-care doctor has become a piece-rate worker focused on the volume of patients seen every day. As Medicare and insurers focused on trimming the costs of the most common procedures, the income and job satisfaction of primary-care doctors eroded.
Both the loss of income and the drop in job satisfaction have contributed to nationwide physician shortages. The U.S. Bureau of Health Professions recently projected a shortage of 109,600 by 2020, and at least 22 states and 16 medical specialty societies have reported an inadequate physician workforce. So far, Congress has done relatively little to address this problem and it will only be exasperated by Obamacare.
While deficit spending is going to be the main priority of the next Congress, the Republicans will face major challenges on that issue as they look for a permanent “doc fix”.