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Issues :: Medicare, Medicaid and SCHIP

Obamacare and its Impact on Doctors
Robert Moffit
Wall Street Journal, 06/19/10

Don't expect doctors to give the Patient Protection and Affordable Care Act a clean bill of health. The act will reinforce the worst features of existing third-party payment arrangements in both the private and public sectors — arrangements that already compromise the professional independence and integrity of the medical profession. Doctors will find themselves subject to more, not less, government regulation and oversight. Moreover, they will become increasingly dependent on unreliable government reimbursement for medical services. Medicare and Medicaid payment, including irrational government payment updates, are preserved (though shaved) and expanded to larger portions of the population. Read more...

Senate 'doc fix' comes too late to avoid physicians' rancor
Julian Pecquet
The Hill, 06/19/10

Senators patted themselves on the back and the White House sought political cover Friday as a 21.3 percent cut to Medicare physician payments went into effect, raising the ire of doctors and seniors across the country. The Senate passed by unanimous consent a six-month, 2.2 percent pay increase for physicians following a late-night deal between Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa), but with the House having already recessed for the week the deal came too late to avert the pay cut. "After years of band-aid patches and short-term fixes, doctors caring for the millions of seniors in Medicare are now reckoning with an unprecedented 21 percent cut to their reimbursement rates," AARP Executive Vice President Nancy LeaMond said in a statement. "This cut creates a dangerous atmosphere for seniors and their doctors, and will contribute to more doctors making the decision already made by some physicians to stop taking Medicare patients." Read more...

Conservatives and the 'Doc Fix'
Stephen Spruiell
National Review Online: The Corner, 06/17/10

Jonathan Chait is upset that conservatives are clinging to a "myth" about the role that the "doc fix" played in the broader debate over Obamacare. Chait is right that some conservatives have incorrectly claimed that Democrats partially offset the spending in Obamacare by pretending that they would not enact the doc fix, even though everyone knew that they would do it eventually. But that doesn't mean that conservatives don't have legitimate gripes with the way the Democrats used a generous version of the doc fix to build support for Obamacare and then, when an early draft came in over-budget, pulled it from the bill, but promised doctors they would pass it later. I wrote a post shortly after Obamacare passed that attempted to explain what really happened. Read more...

Medicare Eye Study Finds Untapped Savings
Alicia Mundy
Wall Street Journal, 06/17/10

Medicare could save more than $500 million annually by using a cheaper Genentech drug to save vision, according to a draft study by federal officials and a University of Miami eye doctor. The study shows that the cheaper drug, Avastin, is already used in about 65% of Medicare patients with wet age-related macular degeneration and accounts for nearly 60% of their eye injections, compared with about 40% for a more expensive drug called Lucentis. However, Medicare paid $537 million for Lucentis in 2008 and only $20 million for Avastin, according to the unpublished study, which was reviewed by The Wall Street Journal. The numbers point to a delicate problem for the federal program for the elderly, whose rising costs are often cited as among the biggest long-term factors in the federal budget deficit. Read more...

Uh, so why did the AMA back Obamacare?
Jeffrey H. Anderson
Washington Examiner, 06/16/10

In passing Obamacare, Democrats not only didn’t address a scheduled pay cut for doctors who provide Medicare services, but they also instituted new pay cuts for other Medicare providers (such as hospitals and nurses), which the Medicare chief actuary says threaten to reduce Medicare patients’ access to care. Simultaneously, the Democrats took money that could have been used to provide a “doc fix” and directed that it instead be spent on Obamacare. Now the American Medical Association, a principal backer of Obamacare (even though the overhaul contained neither a “doc fix” nor a remedy for runaway malpractice lawsuits), wants to have separate, deficit-increasing legislation passed to address the cut in doctors’ pay. Read more...

Doctors Chafe As Medicare Cuts Loom
Janet Adamy and Greg Hitt
Wall Street Journal, 06/16/10

For more than two decades, internist Lee Antles has treated Medicare patients at his practice in Olympia, Wash. Last month, he started turning them away. What pushed him over the edge was Congress's failure to end the looming threat—which no one expects to be carried through—of a 21% payment cut for doctors who participate in the seniors' insurance program. Last year, he and his wife, Margie, who manages the office, took home $55,000 before taxes, he said. Dr. Antles is considering quitting medicine and moving to Chicago, so his wife can return to a sales job that pays at least twice that much. "It just causes me such angst," he said, who would become a stay-at-home father to the couple's six-year-old daughter. "It leaves 1,000 Medicare patients. Where do they go?" Read more...

Renewed Threat Of Medicare Pay Cuts Leaves Doctors With 'Sense Of Fatigue'
Jessica Marcy, Andrew Villegas and Christopher Weaver
Kaiser Health News, 06/16/10

Doctors across the country find themselves – once again – putting their Medicare claims on hold while they wait for Congress to take action.  For the fourth time in six months, physicians are facing a 21 percent cut in their Medicare reimbursements. This cut is an outgrowth of a law passed by Congress more than a decade ago to try to hold down Medicare costs under a formula called the sustainable growth rate.  Under this formula, pay cuts kick in when Medicare payments to physicians outpace certain economic targets. 
Congress has deferred the pay cut every year, except one, since the cuts began in 2002.  And each time, the amount of the reduction has grown. For physicians, this payment-cliff scenario is an increasing source of frustration. While lobbyists urge Congress to enact a permanent payment fix to provide stability to the system, doctors in individual practices regularly brace for the reimbursement roller coaster. Some are so discouraged that they no longer accept Medicare patients. Read more...

Side Effects: Donut Hole Hold-Up
Kathryn Nix
Heritage Foundation: The Foundry, 06/14/10

Last Thursday, the White House trumpeted Obamacare’s first step in closing the Medicare “donut hole.” Checks in the amount of $250 were sent to 80,000 seniors in the “hole”—a gap in Medicare’s coverage of prescription drug benefits for seniors. Ultimately, Washington will cut 4 million of these checks, totaling $1 billion, to help paper over the coverage gap. The gap was no accident, mind you. Congress crafted it deliberately in 2003. It enabled them to claim, with the Congressional Budget Office’s blessing, that the new entitlement to drug coverage under Medicare would cost no more than $400 billion over 10 years. Under the “donut hole” provision, drug benefits run out for some seniors, who must then pick up the total cost of their prescriptions. However, once they pay $3,610 out of pocket, the coverage kicks back in again. Read more...

Obamacare and its Impact on Doctors
Robert E. Moffit
Physicians News Digest, 06/14/10

Don’t expect doctors to give the Patient Protection and Affordable Care Act a clean bill of health. The act will reinforce the worst features of existing third-party payment arrangements in both the private and public sectors — arrangements that already compromise the professional independence and integrity of the medical profession. Doctors will find themselves subject to more, not less, government regulation and oversight. Moreover, they will become increasingly dependent on unreliable government reimbursement for medical services. Medicare and Medicaid payment, including irrational government payment updates, are preserved (though shaved) and expanded to larger portions of the population. Read more...

Will Congress ‘Fix’ the Medicare ‘Doc Fix’ By June 15?
John R. Graham
National Review Online: Critical Condition, 06/11/10

The U.S. Senate enraged organized medicine by leaving town for Memorial Day without plastering another “fix” onto the broken Medicare Part B payment system. If the Senate doesn’t pass a “fix” by June 15, Medicare will start squeezing their paychecks by one fifth. I understand the doctors are upset. But the plain truth is that Congress will never “fix” the payment schedule. Congress attempts to control costs via the Sustainable Growth Rate (SGR), a method instituted in 1997. Physicians cannot stand the SGR because it attempts to limit spending on their services according to growth in real GDP. (The method’s most recent iteration, in all its glory, is described here.) Because medical costs have been increasing faster than GDP, the SGR is pretty much guaranteed to reduce docs’ fees every year it is in place. Read more...

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