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Surgeon’s take on MedPAC report notes more federal involvement, lower reimbursement
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The federal budget is on an “unsustainable path” and the health care bubble is bursting, according to the co-chair of the coding and reimbursement committee of American Society for Surgery of the Hand.
“The government is continuing to attempt to control the cost of health care by both reducing reimbursement to providers as well as by increasing the number and complexity of regulations governing how care is delivered,” Leon S. Benson, MD, told Orthopedics Today. He provided an overview of President Barack Obama’s health care plan and an analysis of MedPAC’s June report to Congress during a symposium at the 2011 annual meeting of the society.
In his summary of the 277-page report, Benson who is also vice chair of the American Academy of Orthopaedic Surgeons’ communications cabinet and chief of hand surgery at Northshore University Healthsystem, noted that MedPAC’s overall tone implies that U.S. health care is generally low quality. He highlighted that the report gives little mention of the aging population and expanding technology.
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Benson also noted that government expansion appears to be a core value in the new health care plans and that inevitably, a lower cost public option will force the hands of providers who will be unable to stay financially afloat and compete, given the new regulations.
Hot topics of the report
Benson touched on four major tenets of the report: improving payment accuracy and appropriate use of ancillary services, enhancing Medicare’s technical assistance and oversight of providers, reforming Medicare’s fee for service program and alternatives to the sustainable growth rate (SGR) system.
As investments in in-house diagnostic testing equipment for practices becomes more common, MedPAC recommended better regulations to improve efficient use of this equipment. The report noted that the system of physician self-referral for equipment could be abused when combined with fee-for-service (FFS) payment systems that rewards an increase in patient volume. According to the report, this self-referral process allows doctors to increase costs by spreading out patient visits as well, which would create redundant co-payments and deductibles for those visits, when certain tests could be performed in a single visit. The solution proposed by the commission is to bundle services and reduce payments for multiple services incurred during a single visit by a single physician, as well as increasing prior authorization for imaging requests by the Centers for Medicare & Medicaid Services or comparable contractors to prevent inappropriate or unnecessary medical tests.
Medicare’s FFS program has also been suggested for reform, Benson said. MedPAC proposed a cap on out-of-pocket expenses for beneficiaries, fixed copayments for office visits and emergency room use, and cost-sharing protection for low-income beneficiaries. The commission also recommended giving individuals incentives, such as a decreased cost, to use high value care rather than low value care methods.
ACOs, SGR fixes
The MedPAC report, Benson noted, also highlighted Medicare’s quality improvement organizations. The commission held that the scope and effectiveness of these organizations could be balanced by increasing the number and variety of technical assistance resources.
Although the Congressional Budget Office has estimated that the cost of replacing or restructuring the SGR in favor of a 10-year freeze in fee schedule rates would be $300 billion, Benson noted MedPAC recommended a new payment structure without the 29.5% scheduled cuts in Medicare physician payment services slated for the end of 2011. According to the report, the new system would improve the accuracy of payments under the physician fee schedule. It would also increase payments for cognitive or non-procedural services relative to procedural services, which would need to be regulated to identify and reduce payments for overpriced services. The commission also noted that it is investigating alternative payment models, such as bundling, medical homes and accountable care organizations.
A physician’s solutions
To tackle these issues, Benson suggested the “enormous cost” of defensive medicine — which encompassed 26% of all health care costs in 2010, according to a Gallup study — be addressed by reforming not just the cost of lawsuits, but the underlying costs that occur when physicians alter their clinical decisions for fear of liability. He also suggested a cap on non-economic damages and recommended health care reform also focus on preventable health care problems, such as smoking, obesity, distracted driving and alcohol-related accidents, which would further reduce costs.
He added that although “hospitals don’t vote,” it is up to doctors to “stay alert” and make themselves advocates by educating themselves on new developments and most importantly, keeping their patients informed.
“It is crucial for physicians to stay engaged in the conversation of how health care is changing and how to best advocate for our patients,” he told Orthopedics Today. – by Jeff Craven
References:
- Benson, LS. What is MedPAC and what does Obamacare mean for you? Presented at the 2011 Annual Meeting of the American Society for Surgery of the Hand. September 8-10. Las Vegas.
- MedPAC. Report to the Congress: Medicare and the health care delivery system. June 2011.
- Leon S. Benson, MD, can be reached at the Illinois Bone & Joint Institute, 2401 Ravine Way, Glenview, IL 60025; 847-998-5680; email: leonbenson@mac.com.
- Disclosure: Benson is a consultant for Trimed, Inc., and a member of the Acumed speakers bureau. He also receives a stipend in his role as current President of the Professional Staff at Northshore University Healthsystem. Benson is a partner at the Illinois Bone and Joint Institute.