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The Message to Doctors: We Don't Care


As a lame duck Congress scrambles to find a temporary compromise on the Medicare physician-reimbursement formula, a weary physician workforce watches and waits, resigned to more months of uncertainty. By not appreciating what this does to physicians' morale, the public is telling doctors that from a federal policy point of view, they simply don't matter.

I’ve spent some time in this space over the past few months discussing what I see as the potential dangers of the current approach to healthcare reform, specifically as they relate to the physician-patient relationship, physician autonomy, and the cost of care. This month, I’d like to talk about a major problem affecting physicians right now that is also related to healthcare reform: the ongoing failure by Congress to fix the Medicare physician-reimbursement formula.

The news is once again full of reports of an approaching deadline on which Medicare payment cuts will take effect. Meanwhile, a lame duck Congress is scrambling to find a temporary compromise, while a weary physician workforce watches and waits, resigned to more months of uncertainty. I can think of no other business in this country that has to operate under these conditions. This is about more than just common sense and sound fiscal policy; it speaks to a lack of respect for the concerns and livelihood of the very medical professionals who must bear the greatest burdens imposed by healthcare reform.

Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston, wrote an interesting op-ed in the Houston Chronicle earlier this month in which he said that the “current squabble in Congress about the Medicare formula for physician payment” should be looked at as an issue of medical ethics. But rather than focus on how this affects the patient -- as is often the case in medical ethics discussions -- Brody suggested that, in this instance, “medical ethics ought to center on the physician.”

On top of the financial uncertainty created by the seemingly endless delays and postponements of Medicare pay cuts, Congress’s failure to find a permanent, workable, and fair solution to this mess is also having another negative effect on physicians in this country. Brody argued that “not appreciating what this does to the morale of the doctors who do their best to provide care for the elderly -- even considering just the continued uncertainty, let alone the potential loss of revenue -- seems a grotesque way of telling American physicians that, from a federal policy point of view, they simply don't matter.”

That is a powerful observation that is getting harder to refute, especially when one considers the likely disaster that would befall American physicians should Congress fail to block the looming 23% reduction in the Medicare physician payment rate. As of this writing, Congress has reached an agreement whereby physicians will continue to be reimbursed at current rates through Dec. 31, the cost of which will be covered by changing reimbursement rates for some outpatient therapy services. However, this cannot go on forever.

Although it seems unlikely, there may soon come a time when budgetary pressures and the spiraling costs of Medicare make it impossible to kick the can down the road one more time, forcing Congress to allow the pay cuts to take effect. What happens then? Consider these sobering statistics from the American Academy of Family Physicians: more than one in 10 family physicians would close their practices; one in seven would stop providing care to Medicare patients; and six in 10 would stop seeing new Medicare patients. Other specialties predict similar dire consequences.

For how long can physicians be expected to run their businesses and practice medicine with this sword hanging over their heads? Many of our readers have told us that they felt taken for granted or even outright ignored by our leaders when key decisions were being made during the health care reform debate, decisions that have the potential to fundamentally alter the health care system and the practice of medicine. The failure to resolve the Medicare payment issue is only one more example of this.

Nobody should be forced to earn a living under the threat that one-quarter or more of their revenue could be arbitrarily snatched away, with no recourse. We ask our physicians to put up with an awful lot in order to provide care to us. It’s time for our leaders to show they care about physicians and end this destructive charade.

Thank you for reading.

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice