Medicare reimbursement issue before Congress again

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Last month, Congress once again passed the buck on Medicare cuts, though this time for just 30 days.

Doctors were relieved, but it makes you wonder: Was that the best approach for the rest of us?

If it had acted, Medicare reimbursements to doctors would have been reduced by 23 percent. But Congress has repeatedly delayed the cuts, which, if they ever are enacted, would inarguably help bring spiraling health care costs under at least some measure of control.

What’s also inarguable is that Congress’s failure to act decisively has cost taxpayers money. The Congressional Budget Office estimates the latest 13-month delay, advocated by the American Medical Association, will cost us $15 billion.

Lawmakers have delayed the cuts four times this year alone. Now they have until Jan. 1 to vote on another delay, or the cuts will go into effect.

Some of the more cynical among them will deny it, but Democrats and Republicans alike are bowing to special interests in putting off the cuts.

Lobbyists representing the AARP, the largest lobbying group in the nation, and the AMA apply continual pressure on Congress to delay the cuts. No sooner does one delay pass than the multimillion-dollar ad and lobbying machines of both groups start up — scaring seniors and agitating doctors.

Doctors claim the government’s payments for the care they provide is failing to keep pace with the costs of running a medical practice. According to the government, that’s true. The Medicare Economic Index shows administrative and medical costs for doctor’s offices rose 18 percent from 2000 to 2008, while Medicare reimbursement fees rose just 5 percent during that time.

Those numbers sure sound dire, right? Many physicians will tell you they can barely keep their heads above water, and many are making the decision to cut Medicare patients or limit the number of visits.

But, are doctors really struggling to make ends meet? Well, some might be. But some aren’t. The Medicare Payment Advisory Commission says doctors have found a new way to make money from Medicare: they’re delivering (and charging for) more services, more tests and more screenings. As a result, Medicare’s total payments to doctors per patient rose 51 percent during the same period of time.

And so it seems that some doctors are practicing unnecessary medicine in order to file more claims with Medicare and extract more money from the government. In response, the doctors acknowledge they’re sometimes engaging in what’s called defensive medicine, the consequence of a rising tide of malpractice claims.

Still, abuses do occur.

One doctor in Maryland, for example, performed more than 580 heart stent procedures that were found to be medically unnecessary. Medicare paid him $3.8 million for the procedures. Dr. Mark Midei is now being sued by his patients, and investigated by the Senate for performing unnecessary procedures and charging Medicare for them.

The case, reported last week in the New York Times, is not unusual, medical analysts say. Inappropriate care has become the norm as doctors increasingly fall back on defensive medicine — not just to stave off malpractice suits — but to line their pockets with federal money.

In fact, volumes are so high that at least one think tank said doctors who concentrate solely on Medicare would see their incomes drop just 9 percent if Congress allowed the cuts it considered last month to move forward. OK, so 9 percent isn’t chicken scratch but it hardly means the poorhouse, given that the average family practice doctor earns about $168,000 a year.

If the cuts are delayed much longer, doctors will be in trouble. Experts say the cuts necessary to stave off Medicare’s collapse will balloon to 40 percent by 2016.

Interestingly, the health care reform bill passed this spring could be the profession’s saving grace.

The law changes the way doctors are reimbursed, moving from a fee-for-service system that apparently benefits physicians who order lots and lots of tests, to a performance-based system based on patient health.

The bill also provides more money to investigate rampant Medicare fraud by patients.

In addition, the new law raises Medicare taxes for the wealthiest 2 percent of Americans and cuts $132 billion in over-payments to Medicare Advantage insurers.

Those three items should halt the ever-spiraling costs of Medicare — and cut the national deficit as well.

But Congress will have to act at some point.

Amy Gillentine can be reached at 719-329-5205 or at amy.gillentine@csbj.com. Friend her on Facebook.