Death By a Thousand Cuts

The Robin Hood analogy of “taking from the rich and giving to the poor,” is completely the opposite for those who are struggling to get by on what they make.

The minimum wage earner flipping burgers has money taken from his meager paycheck to pay for Medicare. Those who are on Medicare have assets (own their own home, savings, pensions etc.), and are relatively “rich” compared to the minimum wage worker.

Thus, in many instances, the government takes from the poor and gives it to the rich.

Government also employs stealth and gradual changes to the Medicare physician fee schedule so as to implement drastic cuts in the fee schedule without physicians noticing.

If you remember when the RBRVS system was implemented, Medicare did it gradually over a period of years. Over a period of about 10 years, fees for some services were reduced by 90%. Fees for other services were reduced less drastically.

While many physicians are so focused on the flawed SGR system and the annual “doc fixes,” avoiding a 24% cut in physician fees, few noticed that the 24% cut in physician fees in Medicare has already been accomplished…gradually.

The 2% sequestration cuts, which went into effect last year, were recently extended by 2 years in the Budget Act of 2013.

Thus, 2% cuts in fees x 12 years = guess what?… a 24% cut in fees.

And, the Budget Act of 2013 also provides that during the 1st 6 months of 2023 the cuts will increase to 2.9%, and then during the last 6 months of 2023 will go to 1.11%.

So, any additional cuts in the Medicare fee schedule that occur between now and 2023 are just “gravy” for those who are looking to drastically reduce what Medicare pays to physicians. And, make no mistake, CMS is planning additional cuts in the Medicare physician fee schedule. Beginning in 2017, CMS will make cuts in “misvalued codes” (mainly for specialists) in order to meet budget targets.

Beginning in 2016, CMS will cut Medicare physician fees for physicians who are not participating in MOC (this includes those who are grandfathered in but not doing MOC).

And that is on top of other planned cuts:

If non-compliant with ICD-10 by Oct 1, 2015, physicians will receive a 100% cut in fees

If non-compliant with e-prescribing, will be subject to a 2% cut in fees

If non-compliant with “meaningful use” (Stage 2 deadline OCt 14, 2014), will be cut by
1% in 2015, 2% in 2016, 3% in 2017, 4% in 2018 and 5% in
2019 and beyond.

If non-compliant with PQRS (based on 2013 reporting data), fees will be cut by 1.5% in 2015 and 2% in 2016 and beyond, and in order to be eligible for the meager 0.5% incentive bonus (2012-2014) physicians must participate “more frequently than is required in at least 1 of the 4 components of MOC, and in particular, must participate more frequently in the practice assessment component of MOC.

And, the saddest fact of all is that those physicians who participate in Medicare (whether they feel forced to do so or not), are agreeing to all of this (i.e. they signed the Medicare participation agreement). The participation rate in Medicare is north of 90%. Congress takes this to mean that more than 90% of all physicians agree to what Medicare is doing otherwise they would have dropped out of Medicare.
Thus, many are contributing to the adversities from which physicians suffer.

I will bet that the “Thrive Not Just Survive” Workshops that AAPS offers are looking a lot more attractive to a lot more physicians knowing the information above.

Also, don’t forget that when Medicare cuts fees to at or below cost, that those services either will not be offered to patients or access to those services will be severely limited due to the fact that no one can provide services continually at a financial loss and still operate a medical practice (a fact that many in Congress, and the president, who have never run a business themselves, don’t appreciate).

So, ultimately, what Medicare is doing is rationing medical care via the fee schedule, which harms patients.

L.R. Huntoon, M.D., Ph.D., F.A.A.N.
Editor-in-Chief
Journal of American Physicians and Surgeons
Editor@jpands.org
Lake View, NY

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One thought on “Death By a Thousand Cuts

  1. The government knows that the doctors are opposed to this agenda. They want doctors to drop out of Medicare so that they can push Obama’s agenda to kill our people by replacing doctors and surgeons with providers to care for our elderly, veterans, and disabled citizens.

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