The Doctor-Hospital Turtle Fix

The turtle lives ‘twixt plated decks

Which practically conceal its sex

I think it is clever of the turtle

In such a fix to be so fertile

Ogden Nash (1902-1971), The Turtle

January 2, 2013 -  Congress thinks of doctors incomes and hospital revenues as a turtle, as something inelastic, caught between two rigid shell decks, therefore non-expansible and fixed.  To keep total health costs from expanding, Congress must make sure when one goes up, the other comes down, thereby  containing the size of the total turtle body.

This is called the zero-sum turtle shell game.   It ignores the reality that, with the population aging and  Medicare and Medicaid demands peaking, the turtle will surely grow over time and expand outside its  shell. The turtle will stick its neck out in search of other turtles, with whom it will procreate.  

As the Mock Turtle in Alice in Wonderland remarked, It’s simply a matter of Arithmetic, “Reeling and Writhing, of course, to begin with, and the different branches of Arithmetic – Ambition, Distraction, Uglification, and Derision.”

At least, that’s the moral I derive from the following article in today’s Kaiser Health News.

Doc Fix’ In ‘Fiscal Cliff’ Plan Cuts Medicare Hospital Payments

By Mary Agnes Carey

       “ Legislation passed by Congress New Year’s Day to avert the dreaded “fiscal cliff” would stop a scheduled payment cut in Medicare physician payments. But hospitals, which have to bear a major part of financing for that “doc fix,” are not happy.

The bill would require that, over the next decade, hospitals pick up nearly half of the approximately $30 billion cost of stopping a 26.5 percent payment cut for Medicare physicians, scheduled to begin today.

The 26.5 percent reduction for doctors comes from a payment formula created in a 1997 deficit reduction law. For the first few years, doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut under that plan. Every year since, Congress has staved off the scheduled cuts.

The package would reduce hospital payments in two ways. First, it would cut $10.5 billion from projected Medicare hospital payments over 10 years for inpatient or overnight care through a downward adjustment in annual base payment increases. The Senate measure also would reduce Medicaid disproportionate share payments to hospitals by an additional $4.2 billion over the next decade. These cuts are on top of those made to hospitals as part of the 2010 health care law.

Groups representing hospitals said the new plans for reductions will hurt their ability to care for patients.

“While fixing the physician payment formula is essential, it should not be done by jeopardizing hospitals’ ability to care for seniors and their communities,” Rich Umbdenstock, president and chief executive officer of the American Hospital Association, said in a written statement.

Chip Kahn, president and CEO of the Federation of American Hospitals, also expressed dismay that hospitals funded much of the doc fix. “It is not in the best interest of patients or those who care for them to rob hospital Peter to pay for fiscal cliff Paul,” he said.

The American Medical Association said that the “last-minute action” is ”a clear example of how the Medicare program is increasingly unreliable for physicians and patients.”

Dr. Jeremy Lazarus, president of the AMA, said “Congress’ work is not complete; it has simply delayed this massive, unsustainable cut for one year. Over the next months, it must act to eliminate this ongoing problem once and for all.”

The bill also would continue a number of Medicare policies known as “extenders.” Those extenders include a wide variety of policies, including special provisions for some low-volume hospitals and charges for ambulance and physical therapy costs.

Other items in the package that would finance the “doc fix” and Medicare extenders include rebasing bundled payments for end stage renal disease (saves $4.9 billion), implementing competitive bidding for diabetic test strips purchased in retail pharmacies (saves $600 million) and reducing risk-adjusted payments to Medicare Advantage plans ($2 billion).

In addition to the physician payment fix, the bill alters tax rates and delays a series of automatic cuts in federal spending, called “sequestration,” scheduled to go into effect Jan. 2. That includes a 2 percent reduction to physicians and other Medicare providers – including hospitals.

While seniors would see no changes in their benefits under sequestration, Medicare providers will face $11 billion in cuts through the end of the government’s fiscal year on Sept. 30.”

Tweet:  Congress treated the doctor fix like a turtle -  expanding doctor Medicare pay while cutting hospitals pay with a common shell for both.