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.
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.”
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
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
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
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 –
Congress treated the doctor fix
like a turtle - expanding doctor Medicare
pay while cutting hospitals pay with a common shell for both.
Post a Comment