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Doctors look to Congress as Medicare fee decrease looms
The Connecticut Mirror ^ | November 30, 2012 | Ana Radelat

Posted on 12/01/2012 8:53:04 AM PST by ExxonPatrolUs

Washington -- Unless Congress acts soon, the New Year will bring plenty of misery for Connecticut's doctors.

On Dec. 31, a temporary measure known as the "doc fix" will expire, resulting in a 30 percent decrease in fees to all doctors who treat patients through Medicare, the government-run health program for the elderly, and active and retired members of the military who are covered under the government's TRICARE program.

"This would basically result in a collapse of our ability to provide care," said John Foley, a cardiologist in Norwich and president of the Connecticut State Medical Society.

Foley said that 37 percent to 40 percent of Connecticut's doctors would stop treating Medicare and TRICARE patients if their fees are slashed.

That would affect many in the state. Connecticut has more than 563,000 Medicare beneficiaries and more than 50,000 active and retired members of the military and their families who are covered by TRICARE.

The perennial panic over the "doc fix" is the result of a formula created by Congress in 1997 that calculated increases in Medicare and TRICARE physician payments on the overall economic growth of the nation. But there's one big problem with this approach: Health care costs have outpaced the nation's economic growth, leaving a multi-billion-dollar shortfall in payments to doctors.

So every year, and sometimes every few months, Congress must appropriate additional money to pay doctors.

Foley, and most fellow physicians, are frustrated by Congress' short-term solutions. They say it's hard to run a business with the uncertainty.

"Congress...tends to kick the can down the road, and we don't want another six- or 12-month [doc fix]," Foley said.

The blame, Foley said, is "poor leadership in Congress."

American Medical Association Executive Vice President James Madara called the short-term solutions a "zombie fix."

"It keeps on coming back from the dead each year in worse and worse form... and you go through that year after year, and you're uncertain, it puts practices at risk and frankly puts our elderly at risk," he said.

Rep. Joe Courtney, D-2nd District, and other lawmakers are pressing for a permanent solution to the problem. They are backing a bill, introduced by Rep. Allyson Schwartz, D-Pa., that would freeze doctors' pay for one year, then give them annual raises for the next four years.

During that time, the Centers for Medicare and Medicaid Services would have to find a new way to pay doctors. Physicians would be penalized for ordering unnecessary tests and procedures for their patients under the plan. But the cost of the permanent doc fix would be high -- as much as $300 billion.

Courtney and other backers of the permanent fix say the money could be found in funds appropriated for the wars in Iraq and Afghanistan that are likely to be left unspent as those conflicts wind down and troops are withdrawn.

Trouble is, there's a lot of competition on Capitol Hill for that pot of money.

Backers of the bill are also hopeful the permanent solution to the doctors' problems can be part of a grand compromise Congress must reach to avoid a "fiscal cliff" at the end of the year.

"The question is, can we get people to focus on this intelligent approach?" Courtney asked.

There will be few other chances to approve legislation in the current lame duck session of Congress. But some say that Congress' bitter partisan fight over spending and taxes needs no additional controversy.

Meanwhile, doctors such as Foley, who works in a practice that employs 40 people and says that at least half of his patients are on Medicare, are concerned about small practices like his being able to stay in business.

"As a state we are still lucky enough to have many small- and medium-sized practices," he said. "But for how long?"

TOPICS: Chit/Chat
KEYWORDS: congress; doc; fix; medicare
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To: buckalfa

You clearly have never run a business. Do you understand the concept of overhead?

21 posted on 12/01/2012 10:58:18 AM PST by dinodino
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To: ExxonPatrolUs

They all need to stop accepting Medicare.

The AARP endorsed this crap, I hope its members figure out they have been sold out soon.

22 posted on 12/01/2012 10:59:42 AM PST by GeronL (
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To: buckalfa

This is a global fee. It includes preoperative workup, the procedure and postoperative care for 90 days. Can easily entail five hours of physician work. Now you’re down to $100 an hour, out of which must come overhead, typically at least 50%. Now you’re down to 50/hr or less. Try getting that rate from a lawyer or even a mechanic. Try to convince a bright young student to take on a few hundred k in debt and at least 11 years of training for that.

23 posted on 12/01/2012 11:38:25 AM PST by armydoc
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To: armydoc
I know all to well as I work in the financial side of a multi-specialty practice.

I was being sarcastic but there is some validity to my point. The current system is financially unsustainable now and in the future. There is simply not enough tax revenue to support current payment levels. Rationing may be inevitable, but I would rather see market forces decide the issue rather than the government. Of course there are no free markets in health care but that is another thread.

I take it from your screen name that your are or were a physician in the military, and for that I thank you for your service.

24 posted on 12/01/2012 12:09:01 PM PST by buckalfa (Nabob of Negativity)
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To: FlingWingFlyer
It appears the ditz has gone over the edge OF THE CLIFF?. Unreal.

If you are calling Ms. Pelosi a ditz, you are insulting DITZes!!

She looks like she fell off a cliff with Wile E. Coyote's ACME Anvil hitting her face.

25 posted on 12/01/2012 12:33:39 PM PST by ExCTCitizen (More Republicans stayed home then the margin of victory of O's Win...)
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To: buckalfa
..................that good doctor would be paid $500 per hour by the program with the lowest reimbursement rate..............

And who pays for the instrumentation, the medical facility,the drugs and anesthesia, the nurse practitioner, the scheduler, the billing clerk, the malpractice insurance, and on and on??

26 posted on 12/01/2012 1:30:01 PM PST by Noob1999 (Loose Lips, Sink Ships)
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To: Froggie

I think if a doctor refuses to see medicare patients , the Feds will make sure this doctor doesn’t get a license to practice in that state. The Feds will be issuing licenses soon, not the state.
Just you wait and see as Rush always says.

27 posted on 12/01/2012 2:23:13 PM PST by pugmama
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They don’t want to fund the great society healthcare programs, they have been raiding them. So IMO they are going to order them to work for far less or they will give them a salary and that will be the end of it.

28 posted on 12/01/2012 9:19:48 PM PST by A CA Guy ( God Bless America, God bless and keep safe our fighting men and women.)
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To: KoRn
Very soon the left will turn their venom towards doctors and other healthcare providers. It’s coming......

Two posts too late, they already did in number ten.

29 posted on 12/01/2012 10:05:44 PM PST by Graybeard58 (What G.O.P.e. candidate is in store for us in 2016?)
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