President’s Message

Medicare Dilemma Leaves Physicians, Patients in the Lurch

As I write this, Washington legislators are preparing to meet in a conference committee to hammer out a federal budget that could have profound effects on Medicare patients and the physicians who care for them (see related article).

Right now, physicians find themselves between a rock and a hard place: It’s hard to support the House plan, which would not prevent a 4.4 percent cut in physician Medicare payments for 2006. According to AMA estimates, such a cut would prompt half of the physicians who planned to purchase information technology to defer that investment. Information technology is critical to the improvements in quality, efficiency, and patient safety that all concerned parties have been clamoring for.

We also cannot fully support the Senate proposal, although it would replace a cut in 2006 with a 1 percent payment increase. The catch here is that the Senate plan imposes a flawed “value-based purchasing” system, which is essentially a pay-for-performance scheme that withholds 2 percent of the physician reimbursement until and unless certain ill-defined “quality” standards are met.

Both the AMA and the MMS have developed principles for physician reimbursement and pay-for-performance programs (see Vital Signs, August 2005, page 3), and some Washington legislators (certainly those in the Massachusetts Congressional Delegation) agree with us. In addition, there is significant Congressional support for changing the fatally flawed sustainable growth rate (SGR) formula by which physician reimbursement rates are now calculated. But any change in the SGR formula will cost money at a time when Congress is looking to cut billions from the budget. So, despite the support for the SGR overhaul, it isn’t likely to happen this year.

There is one thing about this thorny problem that I think the vast majority of physicians can agree on: Any so-called solution to this problem that pits the interests of patients against the interests of their physicians would set up an unconscionable and immoral conflict and is doomed to fail.

As this tangled knot unravels over the next several weeks, I encourage all MMS members to let your senators and representatives in Washington know what you are experiencing in your practice and where you stand on this issue. We must, as always, put patients first.

– Alan M. Harvey, M.D., M.B.A.