Provider Payment "Food Fight"
For some time I have been saying that we are about to have a "food fight" between health care providers over who will sustain Medicare payment cuts--HMOs, docs, hospitals, nursing homes, durable medical equipment, and others.
But even I was surprised by a recent email from the AMA that included this connection between provider payments and food:
“While it’s unusual to think of farmers and hospitals together, the farm bill conference report has thrown them together at the expense of America’s patients. Opponents of physician-owned specialty hospitals are trying to slip a provision to ban specialty hospitals into the farm bill conference report, well after the bill has been passed by both the House and Senate."Get ready for more intramural fights between those who benefit from Medicare and Medicaid. State Medicaid budgets are under pressure as state revenue projections come up short while the Congress needs to find money in the Medicare budget to fix short term problems like the upcoming physician fee cut and longer-term Medicare solvency problems.
Coming up soon will be a big fight over whether Medicare Advantage payments should be cut to pay for a physician fee fix. Maybe even bigger will be the fight over just how the Medicare physician fee schedule will need to be permanently fixed. That fight will happen between the physician specialties--particularly over how primary care payments will get fixed and what role the better paid physician specialties play in that solution.
More on Medicare provider cuts:
Bush Budget Dead On Arrival But It Underscores the Trouble With Entitlements and The Choices That Must Be Made
2 comments:
The dollar bill remains at the core of our health care system. Why?
Physicians should have no ownership in any type of hospital. In general, entrepreneurship for physicians as well as for everyone else should be removed from our health care system. Why should it remain?
Why is the dollar bill the bottom line for American health care as opposed to the degree of penetration of sound, ongoing doctor---patient relationships into every American community?
The argument about physician specialty payments vs. primary care doctor payments is a cover-up designed to obstruct understanding of a more basic problem within the physician community. Primary care is not the foundation of medicine. The doctor---patient relationship is the foundation of medicine, and every physician is ethically bound to fulfill his/her duties within the context of that relationship. Primary care doctors are not the only ones who are capable of delivering primary care. The specialists in medicine are more than capable. They all have to successfully pass through a general medicine residency program before entering a specialty. Indeed, I would suggest that the specialists are capable of delivering a more informed level of primary care.
Current policy discussions all tread water above another underlying fundamental problem in our health care system. GREED has replaced ALTRUISM. Since our politicians are as guilty of this as any other group, they keep themselves blinded and become unable to get to the root causes of the problems within American health care: avarice, lack of acceptance of personal responsibility, and lack of altruism.
True health care reform will not occur until the private health insurance industry is eliminated, and the remaining single payer system places sound, ongoing doctor---patient relationships functioning absent embedded conflicts of interest and absent interference from the payer at the core of our system. What would happen to the almighty dollar biil then? It would assume a secondary supportive role for achieving clear and equal access to sound, ongoing doctor---patient relationships. How naive is this? This is not establishment thinking. This is not thinking that can sustain our current reality.
Even H.R. 676, The United States National Health Insurance Act, authored by Congressman Conyers et al suffers from being dollar driven. The politicians in Washington seem unable to arrive at a deeper level of thinking. Why?
As for the health care proposals of the remaining three presidential contenders, they are nothing but convoluted tweakings of our dysfunctional system.
When health care policy decisions have the doctor---patient relationship as a basis and not the dollar bill, good solutions will evolve for the benefit of everyone living in America as opposed to just those who benefit from Medicare, Medicaid, private insurance and entrepreneurial careers in health care.
R. Garth Kirkwood MD
http://www.equalhealthcareforall.com
doctork@equalhealthcareforall.com
I agree with Dr K up to a point. While our first commitment is to our patients, the Hippocratic oath does not include a provision that we take a vow of poverty, while large systems are reaping huge profits. The "food fight" among specialties has always been there and is a smoke screen that allows some to divide and conquer, we are untied in that the current system is unjust, not only to physicians -we cannot meet our overhead, and as of the June "readjustment" 50% of Medicare doctors will be drinking red ink-but to patients as well. Survey any demographic and ask Medicare recipients how easy it is to find a new doctor. It is not because of greed, but because income cannot meet overhead.
Another thing, why is it correct for other professions to join in entrepreneurial constructs and somehow unseemly for doctors? If the American free market is actually unleashed on health care delivery and we eliminate monopolies, anti-competitive behavior, and publish all prices, we would have private and public health care that really works.
But, in the words of V.I. Lenin, "Medicine is the key to socialism." Perhaps,then, fiscal responsibility under capitalism gives way to the new order. Maybe, we should try the American system for a change....it just might work.
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