Medicare -- Stop the Insanity

You’ve probably already heard that the Senate reversed the first of July 10.6 percent cut in the Medicare fee schedule. Their action also stopped the 5.4 percent cut scheduled for 2009. Instead, you’ll continue to be 0.5 percent better paid in 2008 than in 2007 and will see another 1.1 percent raise in 2009.

Of course, that’s assuming the relative value units for individual CPT codes don’t get changed; you’ll want to double check when the fee schedule comes out.

So, whew. And yet…

As one medical student put it on

The Wall Street Journal

discussion forum, these annual, last-minute reprieves are “like treating cancer with aspirin.” They don’t get to the roots of the problem, including:

• How Medicare has to set its fee schedule;

• The administration’s belief in “free enterprise;”

• Medicare Advantage programs as a cure-all; and

• The absence of any plan to deal with the growing numbers of Medicare patients who, by the way, thanks to technology advances, are getting more and more treatments in the outpatient space instead of in hospitals.

And, of course, each year, it’s another round of fear and blame among physicians. So what do you do?

Most important, decide what you personally want your role to be when it comes to Medicare. There is so much vitriol roiling about the program that individual clarity is important.

Second, take some control. It is difficult for individual physicians to change the system, but that doesn’t mean your only response must be to feel bullied by it. You might decide to drop out of the system, because you simply don’t believe in it. On the other hand, you might decide your relationship with individual Medicare patients simply supersedes the politics.

Or perhaps you’ll resolve to get involved in fixing the problem -- on a large or small scale. Indeed, individuals have changed big social systems, so you might make it your cause to fix this in a way that makes sense for physicians and patients. You could fix it within your own practice by, for example, charging wealthy patients a fee that helps cover the dwindling-to-nonexistent margins on Medicare.

What surely won’t work is waiting for someone else to fix it for you while continuing to complain. It’s your practice, your career, your life.

The system is broken. But that doesn’t mean you need to be.

Pamela Moore is editorial director for Physicians Practice. She can be reached at pmoore@physicianspractice.com.