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AMA Cries for More Cash to Ensure Quality Care

Philip Betbeze, for HealthLeaders Media, October 14, 2011

My point is that just because a payer happens to be a relatively poor one, the government, which now expects more value for its money, doesn't mean you necessarily get to break down your responsibility to provide quality patient care into tinier and tinier bits so that each step in the process is reimbursable.

If you can't make a decent living servicing these patients under the reimbursement system that is currently in place, why not lobby for an overall increase in reimbursement, or better yet, just stop taking new Medicare patients? (My understanding, anecdotally, is that this is happening at a higher and higher rate. Dropping Medicare patients instead of arguing for reimbursement for things that most patients feel you should be doing anyway should eventually solve the problem as seniors, who vote, complain to their legislators). But let's not pretend that the reason healthcare has a big hand in bankrupting us all is because we haven't thrown enough money at it or broken it down into smaller and smaller reimbursable steps.

Look, I'm not suggesting that extra work doesn't go into caring for Medicare beneficiaries who have multiple illnesses. They are a difficult group, and it's OK that the AMA and its members are asking and lobbying for extra payment, but geez, can you imagine the way a system like this could be gamed?

I could be wrong, but I doubt a plea like this will fall on willing eyes and ears at CMS, which is actively discouraging fragmentation of healthcare, not abetting it.

Can't we all agree that fee-for-service healthcare reimbursement is a failure in the sense that patients aren't best served by piecemeal delivery and lack of care coordination? And shouldn't we all agree that once and for all, patient care shouldn't stop at the office door? The whole thing makes my head spin and long for capitation, as many problems as that created.

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5 comments on "AMA Cries for More Cash to Ensure Quality Care"


American Medical Association (10/17/2011 at 3:14 PM)
The recommendation to CMS on reimbursing for coordinated care services was made by a committee of physicians and others (not directly by the AMA). They are seeking to have these critical services, which physicians often already perform, encouraged, recognized and reimbursed by Medicare. We agree with the author that the Medicare payment system is broken and fragmented. The AMA does support stabilizing the Medicare system, where low reimbursement rates and the ongoing threat of severe cuts from the broken Medicare physician payment formula are already forcing 1 in 5 physicians to limit the number of Medicare patients in their practices. Even by the government's own conservative estimate, Medicare payments for physicians are low, with physicians now operating at a 20 percent gap between Medicare's payment updates and the increasing cost of caring for seniors. The AMA is working to make sure Congress enacts permanent repeal of the broken formula and protects access to care for patients. We support enacting a five-year period of stable Medicare physician payments during which time new models of care delivery, which have the potential to coordinate care and reduce costs, can be tested. These new models should form the basis for an improved system as we move Medicare forward.

ps (10/17/2011 at 10:00 AM)
First airlines, then hotels, and now AMA is taking out a chapter from airlines' book of de-bundling services that were supposed to be the part of their contract to provide healthcare. If this is approved, then ALL healthcare providers will follow. There goes our idea for an affordable and accesible healthcare for all Americans down the drain!

mc (10/14/2011 at 8:21 PM)
Thanks so much for Mr. Betbeze's article in HealthLeaders Media entitled, "AMA Cries for more Cash to Ensure Quality Care". His description was insightfully accurate. The more reimbursement-driven our healthcare is becoming, the less patient-centered it is. The situation, especially in our hospitals, is frightening. That we have come to a point where, in order for a healthcare institution or physician to care, we have to first provide a reimbursable situation, clearly outlines the fractured state of healthcare today. Healthcare is becoming less and less individualized, despite all the esoteric reimbursement strategies that are in place in order to show it isn't. Excellent article.