BLOG Medicine

AMA Sounds the Alarm, Medicare Making Yet Another Attempt to Cut Reimbursement

The American Medical Association (AMA) must once again don its armor, this time preparing to go to battle on behalf of its approximately 240,000 members over pending cuts to Medicare reimbursement.  Physicians received below-inflation updates in 2004 and 2005 and zero percent updates in 2006 and 2007.

Without congressional action, Medicare physician payment rates will be reduced 10 percent effective 1 January 2008.  By 2016, the cuts will total about 40 percent, while practice costs are expected to increase by 20 percent.

In addition to steep pay cuts, the AMA charges that the Medicare physician payment update formula:

• has kept average 2007 Medicare physician payment rates about the same as they were in 2001
• prevents physicians from making needed investments in staff and health information technology to support quality measurement
• punishes physicians for participating in initiatives that encourage greater use of preventive care in order to reduce hospitalizations
• has led to a severe shortfalls in Medicare’s budget for physician services that have driven Congress to enact short-term interventions with funding methods that have increased both the duration of cuts, as well as the cost of a long-term solution
• hurts access to care for America’s military families, has payment rates in the Department of Defense’s TRICARE program are tied to Medicare rates

An AMA Physician Payment Action Kit is available for more information and the AMA Physician Grassroots Network to receive updates on physician payment rate legislation.

The impacts of Medicare physician payment cuts in New England are significant:

• New England physicians will lose $306 million for the care of elderly and disabled patients in 2008 due to the 10 percent cut in Medicare payments beginning 1 January.  The region's physicians will lose $12.1 billion for the care of elderly and disabled patient by 2016 due to eight years of cuts
• 149,461 employees, 2,007,382 Medicare patients and 234,343 TRICARE patients in New England will be affected by these cuts
• 42 percent of New England's practicing physicians are over 50, an age at which surveys have shown many physicians consider reducing their patient care activities

	CT	ME	MA	NH	RI	VT
Losses in 2008	$92 million	$27 million	$137 million	$22 million	$18 million	$10 million
Losses by 2016	$3.7 billion	$1 billion	$5.4 billion	$860 million	$720 million	$380 million
Affected:
Employees	39,803	13,671	63,187	14,144	11,613	7,043
Medicare Patients	485,970	220,081	884,894	170,937	155,540	89,960
TRICARE Patients	51,403	46,849	70,159	28,786	24,818	12,328
Physicians Aged 50+	42%	46%	38%	43%	37%	43%

• Compared to the rest of the country, Connecticut, Massachusetts, Rhode Island, and Vermont, each at 14%, has an above-average proportion of Medicare patients
• Compared to the rest of the country, Maine, at 17%, has the second highest proportion of Medicare patients and, at 17 practicing physicians per 1,000 beneficiaries, has a below-average ratio of physicians to Medicare beneficiaries, even before the cuts take effect
• In 2008, on top of the 10 percent cuts across the country, the "Southern Maine" Medicare payment area faces cuts of an additional 1.1 percent, the "Rest of Maine" Medicare payment area faces cuts of 2.1 percent; New Hampshire faces cuts of an additional 1 percent; and, Vermont faces cuts of an additional 1.7 percent

Countering the congressional inaction and the resulting 10 percent rate cut, the AMA is advocating a 1.7 percent increase in reimbursement in 2008, in line with the estimated practice cost increase; long-term, the AMA wants Congress to create a new reimbursement formula.

Over-stepping their role as a payment mechanism and forgetting that they're not actually providers of medical care, the talking-heads of the health insurance industry charge that physicians are partly to blame, contributing to costs by ordering unnecessary and expensive services.  Mohite Ghose, spokesman for the insurance trade association, America's Health Insurance Plans, was even disingenuous enough to question whether physicians are always providing "appropriate services at the right setting at the right time."

BLOG Medicine must concur with the AMA's statement that, "utilization of physician services is not the cause of the Medicare program's financial predicament, and cuts in physician payment rates are not the way to improve Medicare's financial sustainability."  Congress needs to bring up the house-lights and call a close to this "annual dance of death" -- it's time to pay the piper.■

Pollyanna With a Pen: Maine Governor Signs 18 New Health Care Bills into Law

On Tuesday, 17 July, Governor John Baldacci (D-ME), joined by the state's legislative Democrats, signed into law 18 new health care bills meant to protect the health and welfare of the people of Maine.

You couldn't see the rose-colored glasses on his face, but Baldacci's "Pollyanna" was definitely showing in his prepared statement: "What all these have in common is that they provide further evidence that Maine is the leader in health care reform and in efforts to expand access to quality, affordable health care."

Maine, already heavily burdened with healthcare legislation, has added laws that require health insurers to extend coverage to policy-holder's adult children until age 25, to require health insurers to cover hearing aides, to prohibit advertising of prescription drugs on software sold in Maine, to ensure sterile supplies for needle exchange programs, and to regulate access and screening for HIV and cancer.

Increasing health care costs, postpartum depression, eating disorders, and the role of dental hygienists are all to be reviewed by study groups.  November will be Lung Awareness Month, Free Health Clinics will have lower taxes and, disturbingly, despite widely being viewed as an expensive failure and having stopped accepting new enrollees as of 1 July due to cost concerns, Dirigo Health will now be allowed the even more expensive proposition of self-insurance.

Noticeably absent from Tuesday's "Glad Game" shenanigans was a resolution for the much-needed reform to MaineCare, Maine's overloaded and very broken Medicaid program and a new, functional, self-supporting funding-mechanism for Dirigo Health.

The Maine Legislative Documents signed into new law include:

LD 4 -- An Act to Amend the Prescription Privacy Law

LD 101 -- An Act to Enhance Screening for Breast Cancer

LD 144 -- An Act to Support Maine's Free Clinics

LD 243 -- An Act to Establish November as Lung Cancer Awareness Month

LD 429 -- An Act to Improve Access to HIV Testing in Health Care Settings

LD 431 -- An Act to Enable the Dirigo Health Program to be Self-Administered

LD 792 -- An Act Concerning Postpartum Mental Health Education

LD 807 -- An Act to Prevent Overcharging for Prescription Drug Copayments

LD 839 -- An Act to Establish a Prescription Drug Academic Detailing Program

LD 841 -- An Act to Extend Health Insurance Coverage for Dependent Children up to 25-Years of Age

LD 995 -- An Act to Reduce the Expense of Health Care Treatment and Protect the Health of Maine Citizens by Providing Early Screening, Detection and Prevention of Cancer

LD 1044 -- An Act to Address Eating Disorders in Maine

LD 1129 -- An Act to Increase Access to Oral Health Care

LD 1440 -- An Act to Prohibit Inappropriate Software Advertising of Prescription Drugs

LD 1514 -- An Act to Require Health Insurance Coverage for Hearing Aides

LD 1786 -- An Act to Reduce the Spread of Infectious Disease through Shared Hypodermic Apparatuses

LD 1812 -- Resolve, Regarding the Role of Local Regions in Maine's Emerging Public Health Infrastructure

LD 1849 -- An Act to Protect Consumers from Rising Health Care Costs.■

America's Doctor, President's Puppet

Dr. Richard Carmona, the 17th U.S. Surgeon General testified, last week, before the House Committee on Oversight and Government Reform that while he was the nation's top doctor from 2002 to 2006, politics overrode science and belief was more important than fact.

Carmona described a number of topics deemed taboo by Bush administration officials while U.S. Surgeon General, including:

• embryonic stem cell research;
• Plan B, the emergency contraceptive;
• the dangers of secondhand smoke; and,
• the failings of abstinence-only programs

In his speeches, Carmona was ordered to mention President Bush three times for every page and was even discouraged from going to the Special Olympics because of the charitable event's close connection with the prominently-Democrat Kennedy family.

Carmona is quoted as saying, "anything that doesn't fit into the political appointee's ideological, theological or political agendas is ignored, marginalized, or simply buried."

When Carmona quit July 31, last year, public health advocates were critical of Carmona for having not acted more forcefully with an Arizona health department spokesman Michael Murphy sniping, "went out with a whimper, didn't he?", according to the Arizona Daily Star.

Testifying with Carmona were two predecessors, Dr. C. Everett Koop, who served under President Ronald Reagan, and Dr. David Satcher, name by Clinton but whose term ended under Bush.  Carmona told that committee that some of his predecessors had told him that, "we have never seen it as partisan, as malicious, as vindictive, as mean-spirited as it is today, and you clearly have worse than anyone's had."■