TUCSON, Ariz., Dec. 10, 2013 /PRNewswire-USNewswire/ -- Every year there is a battle in Congress to stave off the automatic Clinton-Gingrich "sustained growth rate" (SGR) cut in Medicare physicians' fees that was enacted in 1997. Each year, Congress has delayed it, meaning that the following year's cut, according to the formula, is more draconian, explains the Association of American Physicians and Surgeons (AAPS). The 2014 cut under SGR would be 24.4%.
Since most doctors' overhead is 50% or more, a doctor's actual payment might be zero—or he might have to pay to work.
To survive, many physicians would close their practices to Medicare beneficiaries—or opt out of the program and charge patients directly. In this instance, Medicare denies patients any reimbursement for these doctors' services. But at least the patients can get care—at an affordable price once the doctor can escape costly Medicare busywork.
The American Medical Association (AMA) is lobbying Congress to repeal the SGR and replace it with "alternate payment models."
"The replacement for SGR would be even worse," states AAPS executive director Jane Orient, M.D. "What Congress should do is repeal the price controls. Then patients, not an AMA committee and Medicare bureaucrats, could decide what a service is worth."
"Medicare's job is to decide what to reimburse—not what the doctor charges."
The "alternate payment models" would not pay the doctor for doing a certain amount of work. They would instead pay for things that are largely outside the doctor's control, such as performance of other members of the "team," or how patients do.
Doctors would spend a lot of time collecting extensive data for bureaucrats to put into a formula that pretends to measure "quality" or "value."
"If his patients didn't get well—or die quickly enough—a doctor would be punished," Orient points out. "That's the other side of a 'budget-neutral' incentive that rewards some doctors."
Alternate payment models call for making doctors take a financial risk. "That means a sick patient who needs a lot of care is a financial liability," Orient notes.
Government price-fixing always causes shortages, corruption, and misallocation of resources. An alternate method will not change that.
AAPS opposes the SGR replacement. If Congress insists on price fixing that prevents doctors from working in their patients' best interest, then doctors need to opt out of Medicare.
The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943 to preserve private medicine and the patient-physician relationship.
SOURCE Association of American Physicians and Surgeons (AAPS)