Beware the Ides and Vibes of March

Why are people so tired on April 1. Because they just finished a 31-day March.

Anonymous

March 17, 2012 What ensues is the March 15 Washington Report, written by Lee Stillwell, an Inside-the-Beltway health care consultant, who writes this report for the Physicians Foundation, a non-profit organization with the mission of improving physician practices for the benefit of all Americans.

Hard to believe, but next Friday (March 23) we celebrate the second birthday of Obamacare, the landmark health care legislation that steadily moves us forward to dramatic changes in the practice of medicine and treatment of patients with no end in sight.

The pull and tug of Democratic and Republican forces fighting over the details of the massive law continue to drive both patients and physicians into confusion and uncertainty as polls show the disenchantment with the law growing.

Only a total of 38.3 percent of the American public now support the law with almost half—49.8 percent—against it, according to a compilation of polls by Real Clear Politics. Even worse is a survey from the U.S. Chamber of Commerce that shows three-quarters (74 per cent) of small businesses believe the two-year old law impedes job creation.

Taking into account that today is the Ides of March, a day when superstitions lead to prophecies of doom; I sadly must admit that I believe that political expediency and partisanship continue to prevent Congress and the Administration from finally making the pragmatic decisions that can transition us to a better healthcare system for all.

To get this done, physicians and their patients must hope that there can be an alignment of the stars—an episode that brings all those warring political factions together to do the right thing.

The opportunity to do so starts next week when Rep. Paul Ryan(R-Wis.), House Budget Committee chairman, releases the 2013 budget proposal which represents the thinking of the GOP majority. Reports indicate the budget will be at least $19 billion below the caps established between the Congress and President Obama in a $1.047 trillion budget deal. Democrats already are calling foul and the two sides must find a common ground between the GOP-controlled House, Democratic-led Senate, and Obama.

A meeting of the minds will take some time with big decisions needed not only on the budget, but also for Medicare and Social Security.

I wouldn’t be surprised if this doesn’t occur until after the Supreme Court issues an opinion on the constitutional challenge to the Obama health care law in late June or early July. The case, which will be heard March 26-27, is getting plenty of attention in the capital. Considered the most important domestic legislation since the creation of Medicare in 1965, the court permitted six hours of oral arguments, the most given any case in more than 50 years. The case also has attracted the most briefs in the court’s history—more than 170.

If any portion of the legislation is found unconstitutional, the viability of the law could be called into question. If that occurs, just imagine the political pushback as the November election nears.

Nonetheless, the bureaucracy continues to roll out rules and regulations. Just this week the Department of Health & Human Services issued a 644-page final rule covering state health insurance exchanges. The exchanges will offer one-stop shopping for Americans wanting to purchase health insurance.

Unfortunately, because of the magnitude and complexity of establishing such exchanges, a check of the progress being made by states shows that only 13 have adopted plans so far, indicating that many others will not meet the 2014 start date. HHS will be obligated to run exchanges in states that do not comply.

New provisions in the law will continue to come on line; despite last-minute tinkering with the rules. Such an example is the on contraceptive coverage insurance for woman without out-of-pocket expenses due to start in August. Beginning in September, all health plans must provide concise, consistent plan information for consumers. And it goes on and on.

Intrusion into physician practices continues to be a mounting concern. Just recently, HHS put out a proposed rule from that 2010 health law that penalizes physicians who do not return Medicare overpayments within 60 days of notice. Astoundingly, HHS justifies flagging payments as far back as 10 years!

Some medical organizations are keeping a close eye on the U.S. Preventive Services Task Force (USPSTF) an independent panel of experts that conducts scientific evidence reviews of a broad range of clinical health care services and develops recommendations for primary care clinicians and health systems. The panel caused a stir in recent years with a ruling that woman in their 40s should no longer get routine mammograms and that middle-aged men skip routine screening for prostate cancer. Obviously, such reports affect insurance coverage.

With the tightening of Medicare payment s to physicians, new efforts to repeal the proposed Independent Payment Advisory Board (IPAB) gave new hope to money-starved physician practices—at least momentarily. The effort originally drew bipartisan support in the House, but a GOP effort to add a medical malpractice reform package has killed the bipartisan effort to repeal IPAB and guarantees certain defeat in the Senate. IPAB is designed to curb Medicare spending if it exceeds budgetary targets—and that means further cuts in physician payment.

Speaking of physician payment, the never ending drama over fixing the flawed Sustainable Growth Rate (SGR) continues with no permanent solution on the horizon. Congress has no stomach for finding $316 billion to fix the problem. The current 10-month temporary fix runs out at year’s end –with doctors taking a 32 percent pay cut in January unless new legislation is passed. My prediction is a lame-duck session of Congress will pass another temporary fix of two months come December.

Failure to correct the continuing SGR payment nightmare is maddening to physicians who face growing frustration over rising expenses and growing government intrusion in their practices.

It is no wonder that a survey by The Doctors Company, the nation’s largest insurer of physician and surgical medical liability, showed nine out of 10 physicians would not recommend health care as a profession! Also, the survey indicated 43 percent of physicians surveyed are contemplating retirement within five year because of the changes taking place in the health care system.

To me, these results are shocking. The survey should to be a wakeup call to policy makers and a rallying call for organized medicine. In my opinion, organized medicine “really” needs to come together right now and devise a plan that will be a game changer. If not now, it may be too late to save us all from the turmoil and disruption that lies ahead.

To conclude (Reece Not Stillwell speaking here)

Beware the Ides of March

For Obamacare March looks harsh.

As the soothsayer said to Caesar,

On the 15th you go into the freezer.

Obama, beware of March vibes.

As gurus, pundits , and scribes,

Unleash their jeers and jibes

Without saying what they would prescribe.


Tweet: With Ides of March on 3/15,, Obamacare’s second year on 3/23, and Supreme Court date on 3/26, March may be the month health reform was.