Viewpoints: Problems with the 'doc fix;' a lame budget deal; concerns about changes in doctor training

Dec 13 2013

The Wall Street Journal: This 'Doc Fix' Would Be Bad For Your Health
Imagine if a provision in ObamaCare allowed Health and Human Services Secretary Kathleen Sebelius to dictate directly to doctors which services they could and could not provide their patients-;what individual tests they could conduct, which treatments they could offer, and medicines they could prescribe. Americans would be outraged. Yet some Republicans on Capitol Hill are about to help Democrats pass such a provision for Medicare patients. The Senate Finance Committee is set to vote on permanent "doc-fix" legislation Thursday that grants the federal government broad new authority to determine "applicable appropriate use criteria" for the full range of outpatient medical services delivered to seniors (Scott Gottlieb, 12/11).

The New England Journal of Medicine: Improving Value In Medicare With An SGR Fix
With the end of another year approaching and a scheduled reduction of 24.4% in physician fees, physicians and policymakers are once again concerned about what the sustainable growth rate formula (SGR) that is used to calculate Medicare's physician fees could mean for physician payment. This year, however, is different ... This year, for the first time, bipartisan, bicameral attention is being directed toward developing an alternative reimbursement system that rewards physicians who improve the quality and efficiency of care, rather than just kicking the proverbial SGR can down the road for one more year (Gail R. Wilensky, 12/11).

The New York Times: The Minimalist Budget Deal
The deal will cancel 61 percent of the sequester cuts for nondefense discretionary domestic programs this fiscal year, adding back $31.5 billion over the next two years to be divided among departments like transportation, education, and health and human services. That's a significant achievement, considering that many Republicans want those cuts to continue in perpetuity (12/11).

Los Angeles Times: A Budget Deal With Pain For Republicans And Democrats
A summary of the proposed agreement describes a variety of small-bore cuts and tweaks, including a crackdown on unemployment benefit fraud, less spending on oil-drilling research and smaller cost-of-living adjustments for military personnel who retire before they turn 65. Almost a third of the savings -- $28 billion -- would come from extending the sequester two years further into the future on certain mandatory spending programs, including Medicare and housing vouchers. The agreement ignores the longer-term fiscal problems caused by rising healthcare costs and the shrinking ratio of workers to retirees (Jon Healey, 12/11). 

Los Angeles Times: Washington Lives Down To Expectations, Expects Vast Praise
The negotiators are trolling for kudos for raising revenues without raising income taxes, a maneuver that leaves the tax burden on the wealthy at close to the lowest level in half a century. Instead, they're claiming increased revenues from jacking up fees on air travel. They also expect praise -- or at least [Sen. Patty] Murray, the Democrat, does -- for averting cuts to Social Security and Medicare, which would have been intolerable considering how little is done to exact any sacrifices at all from people at the upper end of the income scale (Michael Hiltzik, 12/11). 

The New York Times: The Toll From Three Deadly Diseases
International health agencies at the United Nations have documented enormous gains made over the past decade to curb three devastating diseases: AIDS, tuberculosis and malaria. Despite this great progress, there is still a big gap between what's been accomplished and what more could be done with sufficient financing (12/11).

The New England Journal of Medicine: Hospital Industry Consolidation -; Still More To Come?
The Affordable Care Act (ACA) has unleashed a merger frenzy, with hospitals scrambling to shore up their market positions, improve operational efficiency, and create organizations capable of managing population health. ... This activity could have lasting repercussions for consumers; the last hospital-merger wave (in the 1990s) led to substantial price increases with little or no countervailing benefits. ... unless new public and private initiatives are developed to discourage consolidation and to support enforcement of antitrust law, most of these deals will proceed unchallenged (Leemore Dafny, 12/11).

The New England Journal of Medicine: Getting Through the Night
[I]n my bad old days, we took call every third or fourth night and did not necessarily (read: never) get real sleep and did not necessarily (read: hardly ever) go home the morning after call, no matter how intense the night had been. ... Yet -; as proof that I'm becoming what is technically called an old fart -; I sometimes feel an almost overwhelming nostalgia for that schedule and the feelings that it brought on. ... I can't defend it from the perspective of patient care, and I wouldn't willingly put anyone else through it. And yet when I look back on certain aspects of that crazy, dangerous schedule, the memories have a certain sweetness (Dr. Perri Klass, 12/11).

The New England Journal of Medicine: A Resitern's Reflections on Duty-Hours Reform
My first year of residency, the majority of the workload still fell on interns, who worked more hours than almost anyone else in the hospital. ... Now, only a little over 2 years later, things have changed dramatically. The new interns still work hard, sometimes as many as 80 hours a week, but they also train for triathlons. ... As senior residents, my colleagues and I -; who didn't have the same protections when we were interns -; had to pick up the slack. We became "resiterns," working many more hours than the senior residents before us in order to make up for the substantial deficiency in intern staffing (Dr. Victoria Johnson, 12/12).