Commentary - February 2008
By William W. Hinchey, MD, TMA President
The Texas Medicare Manifesto
- Fix the formula.
- Put patients before insurance companies.
- Tear down the silos.
As I write this, my Irish blood is still boiling about the U.S. Congress' continued inattention to the serious problems afflicting the Medicare payment system. You'd think I'd be used to it by now. In what's becoming more of a tradition than sleigh bells, carols, and tamales, 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 the best thing to come out of this year's December debacle. It will come to a head again by June, just as the national political parties are preparing for their presidential nominating conventions.
The polls all show that health care is the No. 1 domestic issue in this presidential election cycle. 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.
Although the last-minute fix forestalled an arbitrary 10-percent cut imposed on physician practices, we believe there is no acceptable solution other than a permanent fix to the Sustainable Growth Rate (SGR) 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.
What happened and why
As most of you know, we had been anticipating the 10-percent cut for 2008 for nearly a year. 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. (Hospitals and Medicare HMOs aren't subject to the same rules. More on that in a bit.)
Even though we had been hounding them for months, Congress waited until the week before Christmas to replace the planned 10-percent cut with the wholly inadequate 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.
Many in the physician community outwardly expressed their hope that Congress should do nothing at all, let the cuts come, and watch the whole system implode as thousands of physicians decide 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 limitations on physician-owned hospitals, steep cuts in payments for imaging services, requirements that we use electronic prescribing for all Medicare patients, and some very divisive payment provisions that would have pitted primary care physicians against their procedure-wielding colleagues. 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.
The Texas Medicare Manifesto
The 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, policies, and intentions.
Here's what we're working toward:
- 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.
- No "positive updates," no increases, for hospitals, nursing homes, 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).
- Medicare Advantage plans should 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 from robbing seniors and feeding the health insurance beast.
- 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.
- Action now! We can't let six-and-one-half years of inaction stretch into seven.
We already have started our all-out lobby campaign. We're writing letters to the editor and educating community leaders and our patients. We're calling, writing, and visiting with Sens. John Cornyn and Kay Bailey Hutchison and the 32 Texans in the House. 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. 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.
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.
February 2008 Texas Medicine Contents
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