Tag: "doctors"

Who’s To Blame For Doctors’ Cash Flow Crisis?

Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.

(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)

The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.

More Criticism of the Medicare “Doc Fix”

From Paul Winfree of the Heritage Foundation:

Rather than a permanent replacement to the Sustainable Growth Rate, it is much more likely that the House doc fix will be shorter term patch requiring another series of patchwork legislation just nine years from now.

From David Hogberg of the National Center for Public Policy Research:

When the Senate returns from recess this week, it will consider the “Medicare Access and CHIP Reauthorization Act” (MACR). The bill has acquired many names such as “The Doc Fix Fix” and “Budget Buster,” but a more appropriate one is “IPAB-lite.”

IPAB — the Independent Payment Advisory Board — was created as part of Obamacare to cut Medicare expenditures whenever those expenditures grew too quickly. Thankfully, IPAB’s unpopularity has thus far prevented it from getting off the ground. Unfortunately, the changes MACR makes to Medicare’s payment system seem very much along the lines of what IPAB would do.

(Readers may be forgiven for wondering when I will let go of this so-called Medicare “doc fix”. We expect a vote in the U.S. Senate tonight – but do not guarantee it!)

Chief Actuary Blows Away Make-Believe Medicare “Doc Fix”

A similar version of this Health Alert appeared at Forbes.

On March 25, the U.S. House of Representatives voted for a fiscally irresponsible so–called Medicare “doc fix” that will add $141 billion to the deficit over the next ten years, according to the Congressional Budget Office (CBO). The U.S. Senate will likely vote on the bill later today, and the same lobbyists who dragged Obamacare into the end zone in 2010 are hoping for another win. This one will be even better, because it will be bipartisan.

Nobody denies the way Medicare pays doctors today is flawed. Every year, Congress has to increase the scheduled amount of money because if it did not, fees would drop by about one fifth. Many doctors would stop seeing Medicare beneficiaries.

There are two major differences between this so-called “fix” and previous ones. The first one is real: Previous increases have been offset by cuts to other government spending, and this one is not. The second one is fiction: That this doc fix is a permanent solution to the fee problem.

That fiction was debunked last week in a report published by Medicare’s Chief Actuary.

Federal Rules Create Big Obstacles for Health Information Technology Entrepreneurs

electronic-medical-recordThis blog has long noted the painful consequences of the federal government’s intervention in health information technology (HIT).  Last February, NCPA published an Issue Brief recommending that the federal government’s ambitions in HIT be rolled back. The major problem is the government’s undue influence in Electronic Health Records (EHRs).

Last month, the Administration published the regulations for stage 3 of the Meaningful Use incentives, which both pay and fine doctors for their use of EHRs in accordance with the rules. Margalit Gur-Arie describes the new rules:

Meaningful use stage 3 is adding a host of structured and codified data elements that you will need to collect and record. To that end, you should consider updating your policies as follows:

  • Require each patient to provide an updated resume at least once a year, because you need to continuously collect and update work history, including positions held, and financial information.
  • In collaboration with your attorney, create a crosswalk based on State laws and meaningful use regulations regarding what you must ask or are barred from asking your patients. For example, in some states you are not allowed to ask about guns in the domicile, and for meaningful use you must inquire how often your patient goes to church, and whether he or she is a homosexual (regardless of your specialty). It’s a fine balance, and you don’t want to break any laws.

From Left and Right; Opposition to Flawed Medicare “Doc Fix”

The U.S. Senate will have to deal with the flawed so-called Medicare “doc fix” Wednesday at the latest, if doctors are not to suffer a significant drop in their payments from Medicare.

Voices from both right and left have discovered serious problems with the bill, and proposing solutions. Here are three examples:

Fix The Flawed Medicare Doc Fix

For over a decade, Congress has struggled with an inadequate formula to calculate Medicare payments to physicians.  The formula results in an amount too low to ensure physicians will continue to see Medicare beneficiaries.  At least once a year, Congress has to pass a short-term increase to Medicare physician payments to prevent fees dropping about 20 percent.  The current boost expired on March 31, 2015, and Congress is currently considering legislation, H.R. 2, to fix the problem permanently.

According to a new Issue Brief published by the National Center for Policy Analysis, the currently proposed legislation is a poor doc fix for two major reasons:

Paying for the Medicare Doc Fix is Easy

A similar version of this Health Alert appeared at Forbes.

Late last month, an overwhelming bipartisan majority in the House of Representatives approved the Medicare Reauthorization and CHIP Extension Act (MACRA), a fiscally irresponsible approach to increasing the amount the federal government spends on Medicare’s physicians’ services. Medicare’s Physician Fee Schedule is tied to an inflation formula that is inadequate to pay physicians enough to keep seeing Medicare patients. While Congress has had to increase this amount every year, those increases have always been funded by offsets from other federal spending.

This is the first time politicians of both parties have ignored this rule, increasing Medicare’s physicians’ payments perpetually and not paying for it. Worse, gimmicks obscure the true cost of the bill. Further, the bill would centralize federal control of the practice of medicine along the lines of Obamacare. The bill faces a lot of pressure to pass the Senate next week, especially because Medicare will have to start paying doctors according to a significantly lower fee schedule on April 15. So, the Senate needs to fix the bill very quickly before approving it.

There are three responsible approaches: A shorter “doc fix” that increases physicians’ Medicare payments by no more than two years, which can be easily offset just like 17 previous doc fixes have been; including MACRA on the “pay as you go” (PAYGO) scorecard, making its spending subject to sequestration; or finding $141 billion of offsets required to make the entire bill budget neutral.

Former Bush Official: Medicare “Doc Fix” A Tribute To Big Spender Henry Waxman

Doug Badger, former Deputy Assistant to President Bush on Legislative Affairs, Staff Director of the Senate Policy Committee, and senior official at the U.S. Department of Health & Human Services has harsh words for the so-called Medicare “doc fix” that was rushed through the House of Representatives last month:

The $141 billion health care bill that cleared the House last month and that is expected to win Senate approval next week is a tribute from the GOP-controlled Congress to former Congressman Henry Waxman, a man who worked tirelessly – and with great success – to expand health care-related welfare spending.

The bill (H.R. 2) increases Medicare payments to physicians, largely by replacing one complicated and flawed formula with another. It directs the army of bureaucrats who populate CMS cube farms to soldier on with their futile, half-century-long quest to implement a workable system of administered pricing.

Meanwhile, at the National Journal, Dylan Scott asserts that winning the “doc fix” is “the end for Washington’s most frenzied lobbying extravaganza.” Oh, really? Are all those lobbyists demanding immediate Senate passage of this deficit-financed bill trying to put themselves out of work? I doubt it.

Fixing the Medicare Doc Fix Fiasco

On March 26, an overwhelming bipartisan House majority voted for H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), by 392-37. This bill is the so-called Medicare “doc fix,” a prize that has been chased for many years but never caught by politicians eager to break out of the fiscal discipline a previous Congress had imposed on them.

In 1997, similarly large bipartisan majorities passed the Balanced Budget Act, which introduced the way Medicare pays doctors today. Payments are supposed to be based on the Sustainable Growth Rate (SGR). The SGR was designed to contribute to a balanced budget by linking Medicare’s payments to physicians with a measurement of the nation’s ability to pay for the entitlement: Real Gross Domestic Product (GDP) per capita.

Unfortunately, the rate of growth indicated by the SGR was not adequate to pay physicians enough to see Medicare beneficiaries. So, within a few years, Congress had to find more money. Importantly, Congress always paid for these increased payments by cutting spending in other areas.

This has become increasingly painful for politicians, who now revile the SGR as “broken” and “unworkable.” They act as though the fiscal discipline brought about by the SGR was imposed on them by alien invaders instead of Congress itself.

So, last month, the House of Representatives decided to throw any pretense of fiscal discipline out the window, passing an unfunded “doc fix” that will add half a trillion dollars of debt to the nation’s balance sheet. Further, it increases federal control of the practice of medicine, thereby reinforcing the changes to Medicare introduced five years ago in Obamacare (which explains why President Obama has pledged to sign the bill).

Administration Fears Rejection of Boehner-Pelosi-Obama Medicare “Doc Fix”

As we ease into Easter weekend, the Administration is losing confidence that the Senate will uncritically swallow the Boehner-Pelosi-Obama so-called Medicare “doc fix”.

According to The Hill, the Administration is pleading with the Senate to pass the Medicare Access and CHIP Reauthorization Act (MACRA) immediately when the Senate reconvenes on April 13. If not, the Administration will have to start processing doctors’ claims at a significantly lower rate of payment on April 15.

This pressure mirrors that of Obamacare supporters such as AARP and the American Hospital Association, which are lobbying hard towards the same goal: Recruiting Republican legislators onto Obamacare’s B-Team by getting them to vote for this perpetual extension of the current theory governing Medicare payments, which Obamacare made worse by centralizing decisions about “quality” and “value” in the federal government.

The Administration and Obamacare’s allies had hoped to get a sleepy Senate to rush this bill through on March 26, right after the Senators had pulled an all-nighter on the budget resolution. Fortunately, enough Senators had concerns about the bill’s budget busting-spending that they delayed a potentially catastrophic vote. It would have sent the president a bill that he is eager to sign, and lock in the Obamacare vision of Medicare for the foreseeable future.

Nevertheless, the Senate will have to act pretty quickly on April 13. There are much better policy options than those embraced in the current bill.