TMA President Dr. Hinchey Addresses the Medicare Debacle at Winter Conference

Good afternoon and welcome to the general session of Texas Medical Association's 2008 Winter Conference. Thank you for braving the cold weather and … once again … giving up part of your Super Bowl weekend to work for the betterment of our profession and our patients.

My name is Bill Hinchey. I am the TMA president for another three months or so. What is being shown is not one of Albert Einstein's final exam questions nor the work of a graduate student at MIT, but it may be the most important piece of information affecting the practice of medicine today. 

Ladies and gentlemen this is the formula we know as the SGR or as Dr. David Palafox of El Paso calls it, Stupid Government Regulation.

Unfortunately, because the United States Congress failed to uphold its promise to senior citizens to provide a viable health care system I'll end my term just as I began it, holding Congress accountable to Medicare beneficiaries by enacting a Medicare payment system that makes sense.

I've been to Washington, DC, three times in the past 18 months. I've spoken repeatedly with Senators Cornyn and Hutchison and every member of the Texas delegation. Many of these fine men and women, individually, speak quite truthfully when they say they intend to make things better for our patients and our practices. But … collectively … they just don't get it. It may take every minute of every day of the next three months, but I'll be damned if I'm going to let that stand.

As you can tell, my Irish blood is still boiling about Congress' continued inattention to the serious problems afflicting the Medicare payment system. You'd think I'd be used to it by now. It has become a Christmas tradition worse than fruitcake. Congress in December once again slapped a thin layer of gauze on the gaping Medicare wound.

Instead of its annual one-year patch, though, Washington this time was able to keep things running only for another six months. And that just may be a very good thing, because it will come to a head again by June, just as the political parties are preparing for their national conventions.

The polls show that health care is the No. 1 domestic issue in this presidential election. It will require a lot of hard work between now and June. But if we position ourselves correctly, the political turmoil might provide the leverage we need to succeed.

There is no acceptable solution other than a permanent fix to the Sustainable Growth Rate funding formula. Anything less amounts to the government abandoning its commitment to senior citizens. Neither our patients nor their physicians can live with all this uncertainty.

The ridiculous current law with its SGR formula demands budget neutrality for all Medicare Part B spending. We're caught in a zero-sum game. As more of our patients live longer, become Medicare-eligible, and require medical care, physicians are paid less for each episode of care.

Congress waited until the week before Christmas to replace the planned 10-percent cut with the wholly-inadequate, insulting 0.5-percent payment increase for six months. The pessimists among us realize this will result in the continued slow-bleeding of physicians as government payments fail to keep pace with increasing practice costs.

If you're still not sure what this all means for your practice, TMA has a special hour set aside for you and your staff next Thursday at noon. The flyers at the registration desk have all the details on our Learn At Lunch seminar: Medicare's Lump of Coal. You know that you can count on TMA to help when times are tough.

You also know that many of our colleagues outwardly expressed their hope that Congress would do nothing at all in December, let the cuts come, and watch the whole system implode as thousands of physicians decided they could no longer afford to participate in Medicare at all.

Those who see the glass half-full point out that because Washington waited until almost midnight to act, we avoided some additional poisons that had been brewing in the congressional basements: stark limits on physician-owned hospitals, steep cuts in payments for imaging services, and mandates that we use electronic prescribing for all Medicare patients. Congress just didn't have the time to heap those onto us.

Half-empty or half-full, one thing's for certain. The glass is leaking … badly. We've been operating under government price controls since 1987. Physicians have not had a payment increase that kept up with practice expense increases since 2001. More and more of us … at least those who could  … have been forced to close our practices to Medicare patients or to limit the number of new Medicare patients we take.

Your Texas Medical Association started mobilizing to fashion a permanent solution - and the political might to make it happen - even before President Bush signed the stop-gap bill. We fashioned the "Texas Medicare Manifesto" to hold the government accountable to the promises it made to help us care for our elderly patients and Texans with disabilities. This is a public declaration of our principles … our policies … and our intentions.

First, we need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a stable funding source. The practice of Medicine in 2008 is vastly different than it was in 1965. 

Second, we will accept no "positive updates," no increases, for hospitals, for nursing homes, for Medicare HMOs, or any other Medicare providers until the physician payment system is addressed once and for all for the benefit of our Medicare patients. If that takes "breaking down the silos" between Medicare Parts A, B, and D, so be it.

Third, we must make sure that Medicare Advantage plans' profits do not come ahead of patient care. Why should Medicare Advantage plans make three-times more than the commercial health insurance sector? We need to stop Congress and the President from robbing seniors and feeding the health insurance beast. 

During his State of the Union address Tuesday night, President Bush called for making health care more affordable and more accessible for all Americans. Read my lips, President Bush. If that's really what you want to do, why not start by bringing the broken Medicare system into the 21st century. In the past seven years, your administration has not taken steps to resolve the flawed payment formula.

It doesn't make any sense that individual doctors are being forced out of the system while Medicare Advantage plans and Medicare HMOs are receiving double-digit, multimillion-dollar bonuses for simply brokering existing medical services.

Fourth, we will accept no unfunded mandates, no requirements to use e-prescribing or electronic medical records or to provide new services without the money to pay for it, and we will not allow other issues such as physician ownership to be used as a bargaining chip. The issue is Medicare physician payment reform, and nothing else.

Fifth and finally, we must have action now! We can't let six-and-one-half-years of inaction stretch into seven, eight or nine.

We have already started our all-out campaign for the Texas Medicare Manifesto, but we need your help and your patients' help.

We're writing letters to the editor and visiting editorial boards and educating community leaders and our patients. You can do that, too. Pick up some of the patient flyers at the registration desk. Take them back home and give them to all of your patients.

We have some well-placed, interested, and influential lawmakers on both sides of the aisle in both the House and Senate who do want to help. We're calling, writing, and visiting with Senators Hutchison and Cornyn and the 32 Texans in the House. You can do that, too, and you can ask your patients to make calls as well.

I want all members of the Texas Delegation in Congress to clearly understand that what they passed is insulting, not in the best interest of our patients, not acceptable, and certainly not something we can or will support. 

If you  really want to make a difference, deliver the message in person. Join me on April 1, when our vaunted "First Tuesday" program convenes in Washington, DC. Take part in The March to the Hill as part of the annual AMA Advocacy Conference.

One way or another, please join this campaign. Visit www.texmed.org/manifesto  for facts, talking points, sample letters, and office materials. Do it for your patients, for your profession, for your practice. We may never have a better opportunity. Let's make it our patients' and our practices' greatest success.

Download Podcast TMA: The Texas Medicare Manifesto


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