I don’t know what to say about that, or even if anything needs to be said, but it was pretty cool.
Now, you might ask what I was doing in the basement of the Senate office building. I spent most of Tuesday lobbying on behalf of Family Medicine, and we had three major points to make:
The current equation that Medicare uses to pay physicians in flawed. It was passed in 1997 as one of Newt Gingrich’s signature bills, right after his party took over the house. The House Republicans weren’t happy with how much money Medicare was spending (nobody was, or is). They wanted to curb the expenses, so they went after doctor’s pay. As you know, I’m usually the first person to say that most doctors (particularly specialists) are paid far too much, but the problem with this bill is that physician pay is a very, very small component of total Medicare expenses, so cutting it would have a negligible effect on the overall expenses. But doctors are generally one of the more politically inept interest groups (silly us for focusing on our patients, and not politics), so we were an easy target. Congress is very, very weary of going after the insurance industry.
But even that same Congress realized that this was a bad bill, so they passed a short-term “Pay fix” bill that pulls money from other pools of money to make up for the difference between what Medicare was supposed to pay doctors under Gingrich’s plan, and what it actually pays them (under the old formula). The problem is that because of how Gingrich’s formula was written, the difference between real pay and “on the books” pay widens further every year, and it’s getting harder and harder to cook the books. In fact, last year, Congress couldn’t figure out how to pass the most recent pay fix, and the Gingrich rate kicked in. Overnight, doctors took a 30% cut in their Medicare pay, and it wasn’t resolved for two weeks.
Now, to balance out my Congress bashing, the Democrat Congress should have repealed the Gingrich pay rate as part of last year's healthcare reform law, but that would have obscured the benefits of that bill, since some of the cost savings would be negated by increasing the “on the books” pay rate for doctors.
What all physician groups are asking for (including the Academy of Family Physicians and the AMA) is that Congress pass a 5-year pay fix (instead of the current few months at a time), so that we can work with Medicare to come up with a more permanent solution.
Now, to balance out my Congress bashing, the Democrat Congress should have repealed the Gingrich pay rate as part of last year's healthcare reform law, but that would have obscured the benefits of that bill, since some of the cost savings would be negated by increasing the “on the books” pay rate for doctors.
What all physician groups are asking for (including the Academy of Family Physicians and the AMA) is that Congress pass a 5-year pay fix (instead of the current few months at a time), so that we can work with Medicare to come up with a more permanent solution.
But in my opinion, this isn’t one of medicine’s more pressing issues. We’re using a lot of political capital to keep the pay cut from kicking in, and the general public isn’t all that sympathetic to doctors’ pay. And asking for more money in this political climate is a complete non-starter. But the whole point of organized lobbying is that we’re far more effective as a group. So when the Academy holds a vote, and the majority of physicians are in favor of pursuing a pay fix, we all lobby for it, even if many of us aren’t convinced that it’s the most effective use of our resources.
The other two issues that we lobbied for are much more important to me, and I think that they will have a far greater impact on the overall healthcare system. We want to increase funding for primary care medical education. The trip that I took to the Hopi reservation last summer was funded by this pool of money, and the trip was probably the single most powerful event that convinced me to become a family physician. These programs are an extremely cost effective way to address the shortage of primary care physicians. However, this isn’t a great time to ask for more funding for anything, so we got some pushback from some of the more conservative members of Congress. It’s an investment that will save the system a lot of money over the long run, but many people don’t see past the initial cash expense.
The last issue was an interesting one, and one that has the added benefit of not costing the government any more money. It relates to how our country pays for residencies (the time between medical school and being a grown-up doc). Since residents are fully licensed physicians, they can see patients in the clinic and they can perform procedures. This brings in money for the program that is training them, but it is usually not enough money to offset residents’ salaries (which are usually in the ballpark of $40,000). So if this arrangment wasn’t subsidized, hospitals would have no financial incentive to train more physicians, and we’d have a serious, serious physician shortage in about 15 years.
Since we receive a collective benefit from having enough doctors, we all chip in to cover the costs. Part of our Medicare tax goes towards funding residency programs. You pay about $2.50 per year towards this, and we really do appreciate it. However, this money is paid to hospitals for them to use as they please. So it should come as no surprise that hospitals are going to funnel this money into the most profitable residency programs. So even though it saves us all an incredible about of money to have a primary care-focused healthcare system, it is far more profitable for a hospital to crank out more neurosurgeons (since neurosurgery residents perform procedures that bring in far more money than the procedures done by family medicine residents). This is why "free market principles" work great when you’re making shoes or selling computers, but they are very counterproductive in most aspects of the healthcare system.
What we asked for is that Medicare distributes the residency money to a wider variety of players in the healthcare system. Hospitals will continue to (and should) receive the bulk of that money, but we want to see community health clinics, small physician groups, and rural hospitals also receive some of this money, since they are far more likely to train primary care physicians. And since this proposal has the added benefit of being budget neutral (we’re just moving money from one account to another), Congress was pretty receptive. The hospitals won’t be crazy about this proposal, but as long as they don’t fight it too hard, I’ll bet that Medicare will start diversifying its residency funds in a year or so.
Something about D.C. just keeps bringing out these political postings, but we’ll be back to poop jokes and travel photos in no time.
M
The other two issues that we lobbied for are much more important to me, and I think that they will have a far greater impact on the overall healthcare system. We want to increase funding for primary care medical education. The trip that I took to the Hopi reservation last summer was funded by this pool of money, and the trip was probably the single most powerful event that convinced me to become a family physician. These programs are an extremely cost effective way to address the shortage of primary care physicians. However, this isn’t a great time to ask for more funding for anything, so we got some pushback from some of the more conservative members of Congress. It’s an investment that will save the system a lot of money over the long run, but many people don’t see past the initial cash expense.
The last issue was an interesting one, and one that has the added benefit of not costing the government any more money. It relates to how our country pays for residencies (the time between medical school and being a grown-up doc). Since residents are fully licensed physicians, they can see patients in the clinic and they can perform procedures. This brings in money for the program that is training them, but it is usually not enough money to offset residents’ salaries (which are usually in the ballpark of $40,000). So if this arrangment wasn’t subsidized, hospitals would have no financial incentive to train more physicians, and we’d have a serious, serious physician shortage in about 15 years.
Since we receive a collective benefit from having enough doctors, we all chip in to cover the costs. Part of our Medicare tax goes towards funding residency programs. You pay about $2.50 per year towards this, and we really do appreciate it. However, this money is paid to hospitals for them to use as they please. So it should come as no surprise that hospitals are going to funnel this money into the most profitable residency programs. So even though it saves us all an incredible about of money to have a primary care-focused healthcare system, it is far more profitable for a hospital to crank out more neurosurgeons (since neurosurgery residents perform procedures that bring in far more money than the procedures done by family medicine residents). This is why "free market principles" work great when you’re making shoes or selling computers, but they are very counterproductive in most aspects of the healthcare system.
What we asked for is that Medicare distributes the residency money to a wider variety of players in the healthcare system. Hospitals will continue to (and should) receive the bulk of that money, but we want to see community health clinics, small physician groups, and rural hospitals also receive some of this money, since they are far more likely to train primary care physicians. And since this proposal has the added benefit of being budget neutral (we’re just moving money from one account to another), Congress was pretty receptive. The hospitals won’t be crazy about this proposal, but as long as they don’t fight it too hard, I’ll bet that Medicare will start diversifying its residency funds in a year or so.
Something about D.C. just keeps bringing out these political postings, but we’ll be back to poop jokes and travel photos in no time.
M
