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NASS offers specific proposals to improve patient care, reduce Medicare spending
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Medicare expenditure growth and the reduction of national health care expenditures are among the key points for a well-functioning physician reimbursement system, according to a seven-page letter from the North American Spine Society to the House Committee on Energy and Commerce.
The letter, sent in response to a request from the House Committee on Energy and Commerce, outlines and then elaborates upon North American Spine Society (NASS) recommendations for a physician reimbursement system that NASS reports will cover the cost of providing health care to the nation’s seniors while maintaining and promoting access to specialty care.
“NASS welcomes the opportunity to participate in the important discussion on how best to improve the specialty care we provide patients, particularly on our nation’s most vulnerable — our seniors,” Gregory Przybylski, MD, president of NASS, stated in a release. “As patient and physician advocates, we are in a unique position to help create a sustainable system that promotes access to much-needed specialty care and covers cost.”
The letter provides data and recommendations on a number of topics, including:
- Medicare expenditure growth;
- Physician component of Part B expenditures and growth;
- The development of fair value for codes with regards to physician payments in the United States;
- The reduction of national health care expenditures;
- The failure of the sustainable growth rate;
- Options for replacing the sustainable growth rate; and
- Specific value-based model proposals.
“Broad consensus exists among the medical profession, Congress and various other stakeholders that the current sustainable growth rate formula used to determine annual physician payment updates is an unfeasible long-term solution that does not reflect the true costs of providing care to Medicare beneficiaries,” the letter reads.
The letter continues by noting that any system built to replace the “flawed” sustainable growth rate formula should take into account numerous aspects of Medicare outlays — such as Medicare expenditures to non-physician providers. Furthermore, it should avoid disproportionate annual updates to stakeholders within Medicare and identify the value associated with specific elements of care.
The effort of incorporating the proper value parameters, NASS noted in the letter, could be facilitated through a short-term transitional system spanning 3 to 5 years and based on the current sustainable growth rate formula as well as a future value-based payment system.
“NASS stands ready to work with [the Centers for Medicare & Medicaid Services] and Congress to explore alternative payment systems focusing on value through development of demonstration projects and future participation in Congressional committee testimony, should it occur,” Przybylski stated in the release.
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The NASS letter does a nice job of highlighting that physicians are being asked to bear a disproportionate share of the Medicare cuts compared to hospitals and others in the health care industry. However, to really win the health care debate, I believe it is necessary to challenge the conventional wisdom that “we spend too much on health care.” I suspect most people would spend their last dollar on health care, as long as that dollar is yielding a return.
It is wrong to assume that spending X percent of GNP on health is "too much." I think physicians should help frame the debate by asking "do you value the medical care that you receive? Do you think we should cut back on the care that you get?" Most policy makers are talking about cutbacks to services that they would expect to receive if they — or a loved one — were ill. As soon as we concede we "spend too much" on health care, people seeking to ration care have won the debate. The resulting infighting between various health care providers weakens everyone. Rather than fighting over the allocation of the last piece of a shrinking pie, it is better to reframe the debate to preserve, or even increase the piece of pie. Would you spend your last dollar on a milkshake, or a surgery that would save or improve your life? The answer says a lot about whether we spend "too much" on health care.
— David M. Glaser, JD
Orthopedics Today editorial board member
Minneapolis, Minn.