Physicians raise concerns about proposed Medicare changes

The health care legislation being considered by Congress seeks to reform Medicare and look for alternatives to the fee-for-service payment system, which critics say discourages care coordination and quality. American Medical News reports on one alternative called bundling, in which "doctors and hospitals are paid for all services to a patient in an episode of care for a particular condition. ... Hospitals already have experience with a form of bundled payments through the diagnosis-related group payment system. But extending the concept to physicians would encourage doctors and hospitals to work together to control costs and improve quality, stated the Medicare Payment Advisory Commission in a June 2008 report calling for Medicare to test payment bundling."

Doctors have concerns about the proposed new method, including "that sending the lump payments to hospitals would give hospitals too much control over physician rates, that bundled pay would provide an incentive to skimp on needed care to maximize profits, and that a focus on acute care episodes would leave primary care doctors out in the cold" (Aston, 1/4).

See related KHN story on bundling.

Meanwhile, cardiologists are criticizing cuts to Medicare payments. The (Fort Myers, Fl.) News-Press reports "new Medicare rules taking effect this week will slash payments to heart doctors for some of the most common exams and, cardiology groups argue, could eventually lead to layoffs and treatment cutbacks. The 2010 Obama administration guidelines decreased reimbursements for certain tests by 10 percent to 40 percent over the next four years, starting Jan. 1, according to the American College of Cardiology. ... Local cardiologists say reimbursement decreases over the years have forced them to cut staff and have led to longer patient waits." (Gluck, 1/4).