Senator Baucus’ Answer to Who Should Pay for Primary Care? As usual, Bob Doherty nails the issue. Baucus completely understands the problem. These are the highlights:
A process would be created to reduce payments for services found to be overvalued under the Medicare physician fee schedule and redistribute them to increase payments for undervalued primary care services. The paper implies that this review would take place outside the usual RVS Update Committee (RUC) process.
I (and other bloggers) have highlighted the problems of the RUC over that past year. We will not get fee schedules to appropriately value primary care services without such reform.
The changes in physician payment will be budget neutral, meaning "that any increase to primary care providers requires a corresponding cut to specialist services." The paper acknowledges that such redistribution "has the potential to create significant controversy among physicians."
No kidding. Every effort over the past twenty years to increase payments for primary care has created enormous controversy within medicine.
Bob Doherty finishes with this:
Today’s questions: Do you agree with Senator Baucus that primary care is the "keystone" of a high performing health care system and needs to be supported with higher fees, even if that means taking money from other specialists, including some internists? If you don’t believe specialists’ fees should be cut, then how would you recommend Senator Baucus and his colleagues pay for higher primary care payments–if at all?
I wish that we could fix this problem without having winners and losers, however, the reason that we have this problem is because we have already had winners and losers for 20 years. For 20 years, internists and family physicians have lost relative to other physicians.
I have posted with much frustration over the past two weeks. I understand that money and life style will rule medical student and resident decision making. We (the country) need more internists and family physicians. By increasing payment, we will have more internists choose outpatient medicine and more students choose both fields.
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6 Responses to I hope Obama listens to Baucus
SteveSC
November 14th, 2008 at 9:02 am
Divide and conquer.
The RVS was used to buy off proceduralists into accepting centralized price setting. Now, in classic form, the claim is that the ‘disadvantaged’ physicians have to be ‘made whole’.
Budget neutral means no overall increases in physician income, despite increases in the population and increasing utilization as the population ages. Who really believes that primary care docs will get a significant increase? This is just a way to drop the payments to proceduralists.
The next step will be–since there ‘isn’t enough money’ to significantly increase primary care docs–to push more NPs and PAs into independent primary care, since they are ‘cheaper’.
Dr Dan
November 14th, 2008 at 1:14 pm
I certainly second SteveSC’s observations about the not-so-stealthy insertion of NPs and PAs to replace primary care docs. I still have not been reassured that the medical home idea embraced by my own academy will end up being anything other than a trojan horse. We will wake up and find that we have a de facto capitation system: our patients will require referrals from us, increasing the hassle factor and producing an adversarial relationship. Our “management” fees will depend on decreased utilization of specialists’ services and testing. If that isn’t capitation, what is it?
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