Berwick, Medicare, Medicaid, and the Rest of Us

Donald Berwick, MD, two months after his recess appointment as Administrator of Medicare and Medicaid services, has finally wandered out of his lair in Washington, to state the case for the Affordable Care Act in the Washington Post.

Berwick says,” It's no illusion to the seniors and people with disabilities who will pay less for prescription drugs, to the millions of Medicare beneficiaries who will have preventive care and check-ups covered without paying co-pays, or to the people who will be protected from fraud and abuse. Under the act, Medicare is stronger than it has been in years, and seniors will get new benefits.”

Berwick maintains the Affordable Care Act will reduce costs by eliminating Medicare Advantage plans and will put Medicare on a “surer footing.”

He assures us, “The act encourages some of the most comprehensive payment and delivery system reforms in Medicare's 45-year history. It establishes a Center for Medicare and Medicaid Innovation within CMS to help find ways to modernize our health-care system to make it safe, patient-centered, reliable, sustainable and efficient. These approaches, endorsed by health-care organizations, employers and economists, will help make the health-care system of higher quality and more affordable for America's families and businesses.”

In short, Doctor Berwick cheer leads for the Affordable Care Act. This is understandable, considering his position.

What Doctor Berwick does not mention is how the proposed health reform act will impact care for the non-Medicare, non-Medicaid population, comprising 70% of Americans, or the physicians who provide that care.

So far this much is clear. The Affordable and Patient Protection Act has no real cost controls. It will sharply increase costs for private plans in the short term, as we shall soon see with sharp spikes in health care premiums in October and November of this year and transfer of more costs to employees by employers, as they struggle to cope with new expenses and provisions imposed by the new law.

Berwick fails to state the plight of state governments, whose already strained budgets are likely to be crushed under burdens of millions of new Medicaid patients and setting up health exchanges.

And ACA will fail to “protect” Americans who want to retain their present plans. Instead patients with these plans will have to switch to federally approved one-size-fits-all “comprehensive and coordinated” plans, which will inevitably cost more.

Furthermore, the ACA may not “protect” citizens who desire further access to physicians, many of whom may restrict or cease care to Medicare and Medicaid recipients because of costs of regulations and burdens of limited reimbursements, which together may make it impossible to maintain viable practices.

And as for improving the quality of care, who knows? Physicians who serve the old and the poor and the sick have not been consulted.

Few have bothered to ask the U.S. physicians what they think of this reform. Will their ability to offer quality care be improved or hampered? Is the business of practicing medicine getting easier – or harder? For answers Athenahealth recently partnered with Sermo’s online community for physicians to conduct a first of its kind Physician Sentiment Index (PSI).

In this first annual index, 1,000 physicians – representing a range of specialties, regions, and practice sizes – responded to questions revealing frustrations with the business of medicine, reimbursement protocols, government’s hand in health care, EHRs and other variables that could either make or break the delivery of quality care in the U.S.

Here were the top physician sentiments.

• 92% agree getting paid by insurers has become increasingly burdensome and complex.

• 83% agree this is the case with Medicaid.

• 81% agree this is the case with Medicare.

• 64% believe their clinical decisions are based more on what payers will cover than what is best for their patients.

• 59% think the quality of medicine in the U.S. will decline in the next five years.

• 54% agree more government involvement will decrease quality.

In October, the Physicians Foundation will release a survey of more than 40,000 physicians on how they view reform. That survey, whose results are not yet fully known, will explore in more detail the impact of the Affordable Care Act on patients and physicians.

Given growing physician shortages and increasing exodus of independent physicians from the Medicare and Medicaid scene because of federal policies, it would not impudent to ask Doctor Berwick, "Who shall care for the the old, the sick, the poor, and the rest of us?"