Heart, cancer doctors get break on scheduled Medicare pay cuts

Nov 2 2009

"Heart and cancer doctors will get a smaller fee cut next year from Medicare, the U.S. government program for the elderly, than the Obama administration first sought in a move to shift money to family physicians," Bloomberg reports. Earlier this year, Medicare officials said they would cut 10 percent of payments for the two specialties. Now, they plan on making the reductions over four years, instead.

"The administration argued that the lower reimbursements for specialists would make more dollars available for lower-paid non-specialists who can focus on preventing expensive, chronic illnesses. That would tame the growth in medical costs, one goal of President Barack Obama's effort to remake the U.S. system of care. Under yesterday's plan, family doctors and nurse practitioners would get half the proposed increase." A lobbyist for cardiologists said he expected many heart doctors to flee the specialty that the cuts would lead to their "slow death."

The fee schedule for these specialists is part of a broader, regularly-scheduled Medicare payment plan. The blueprint for the coming year "includes a 21.5 percent cut for all physicians, about 1 million in total, who treat Medicare patients. The Senate Oct. 21 failed to pass a bill to permanently repeal the broader cut, at a cost of $247 billion over a decade. Lawmakers have said they'll instead try to postpone the fee reductions for a year" (Nussbaum, 10/31).

Meanwhile, a recent survey of health care opinion leaders by Modern HealthCare/The Commonwealth Fund finds that most experts - over 80 percent - believe Medicare has succeeded at providing access to medical care and predictable health benefits during its 44-year existence. But, the survey also found that only 6 percent believed Medicare had been wise in using its enormous leverage to improve quality; 3 percent said it had succeeded at using leverage to lower costs; and only 3 percent said it had used its leveraged to promote better health system performance.

Changes like negotiating drug prices were top areas for increased leverage. Over 80 percent of the respondents favored the practice while only 14 percent opposed it. "Another proposed Medicare-reform policy intended to improve care and lower costs is the concept of the 'bundled' payment. It would be a single payment for all services provided to a beneficiary for a specific period of time, such as payment for acute-care episodes..." According to the report, 65 percent of respondents favored 'bundling' while only 7 percent opposed it (Zigmond, 11/2).