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Friday, October 23, 2009

Doctor's Wake Up!
(Copy and paste in your browser to link to this Washington Times editorial)

My father had back surgery today. His procedure called for a vial of protein fluid that is used in back surgery instead of the steel rods. This vial costs $5,000. It's use is safer, and more successful than steel rods (although admittedly there is more than one way to skin a cat). However, Medicare (and subsequently private insurance companies) now pay surgeons far more for doing a back surgery procedure with steel rods (upwards of $50,000 for putting it in and the same amount for taking it out.)Surgeons using the alternative method utilizing the vial protein instead of steel rods are paid much, much less for the procedure. If the Medicare cuts of 21.5% occur in January 2010, as scheduled, this procedure will not be available for patients because it will not be affordable for orthopedists to perform. A 21.5% cut in the amount the orthopedist will be paid makes this procedure too costly for surgeons to undertake for the time it requires. Orthopedists who have chosen a method that is less costly and arguably safer and more effective will simply not be able to afford to do the surgery using that material.

The Senate began it's consideration of S. 1776, the “Medicare Physicians Fairness Act of 2009,” on Monday afternoon, Oct. 19. This just-introduced legislation eliminated the 21.5 percent cut in Medicare physician reimbursement for 2010, repealing the sustainable growth rate (SGR) formula . The Senate leadership had indicated that enactment of this bill would set the foundation for creating a new Medicare payment update system - a much needed update. The Medical Group Management Association had partnered with the American Medical Association utilizing its toll-free number to focus the collective grassroots efforts of both organizations. Unfortunately, there was not enough time for voices on this bill to be heard as it was successfully squashed by members on Wednesday. The passing of this bill would have done much to get doctors behind the health care reform legislation. However, this drastic reduction in Medicare reimbursement due to occur in January 2010 brings us one step closer to a health system that eliminates the private practice physician. And this is why: a 21.5% cut in Medicare payments to physicians will force many private physicians (those physicians not already employed by a VA hospital, a university, or a health insurance company) to become employed by a larger entity such as their private community hospitals. This is the ultimate goal of our federal government, who want to implement a one-payor system of health care delivery. Hospitals will be issued payments directly, to then be doled out to their employed physicians. You do not want to see this happen. Medicine will continue on a path towards being dictated by business models instead of quality care issues. Admittedly this has been happening for years with managed care by the insurance industry as well as government regulation. However, this takes it one step further, and closer to a one payor system, and it is a huge step.

According to my father's orthopedist who practices in the D.C. metropolitan area, he and members of his specialty are being urged by their American Board (he was personally called by the President of his Academy-unprecedented in his 20 years of practice) to drop Medicare patients if this 21.5% cut is not repealed. Last week, sixteen joint replacements were scheduled with this one orthopedic surgeon in one day - UNPRECEDENTED and indicative of the kind of fear people are having that our system will be changing, and not for the better. Are these hysterical reactions from professionals who are just trying to protect their level of income? Are people fearful because they have been worked up to a frenzy? There are many who think so.

However, the truth is many in his specialty and others will not be able to keep their doors open with the proposed Medicare cuts. As mentioned, hospitals are already positioning themselves to absorb these private practice surgical offices. But a large number of surgeons will refuse to become employed by an entity, any entity, that will ultimately dictate the way they practice medicine and influence their individual medical decision making which they may deem best for patient care. The neurosurgeon on my father's case echoed the orthopedist's sentiments. This Administration should be prepared for a huge back lash as physicians will unite to stem what they will perceive as the demise of quality medicine.

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