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'Doc Fix' is Unfixable

 |  By jcantlupe@healthleadersmedia.com  
   December 08, 2011

Anders Gilberg, a senior VP at the Medical Group Management Association, heard National Public Radio commentators discussing the "doc fix" on his commute to Washington, D.C., the other day.

Gilberg felt good that panelists and politicians were even talking about the issue. That's because in the nation's capital, if it's being discussed, there's a possibility that something may actually happen on Capitol Hill, he says.

Gilberg and other observers believe there is a good chance that Congress will take up the doc fix before the January 1 deadline. If the House and Senate don't act by then, it means a 27.4% cut to Medicare providers on the first day of 2012. The pain would be palpable.

Holiday adjournments may get in the way, although Democratic leaders in the U.S. House of Representatives have called on their Republican counterparts to act before December 16.

Despite politicians' talk about a doc fix, though, the problem never really gets fixed—just put off for another time.

Last year, the doc fix was continually on the ledge. Congress stalled six times and imposed "patches" on the Medicare Sustainable Growth Rate payment formula to stave off cuts that would have amounted to 20%. Since 2003, Congress has taken steps each year to override the cuts required by the formula.

 "The scheduled cuts have increased from 5% in 2002 to the current level of 27%," Peter W. Carmel, MD, president of the AMA, writes in a recent blog.

"The number of older Americans whose access to care is threatened by these cuts continues to rapidly multiply as 79 million baby boomers have begun joining the ranks of Medicare patients. The cost to repeal the SGR has risen from $48 billion in 2005 to $300 billion today. And that figure keeps growing," Carmel writes.

While the physician organizations have been beating the drum for political action, Lucien W. Roberts III, MHA, FAMPE, a former medical practice administrator and vice president of a firm that consults with physicians, detects a deafening silence among rank-and-file physicians over the doc fix. Physicians "are distracted" by so many other complicated and pressing issues, such as ICD-10, he tells HealthLeaders Media.

Roberts counsels physicians to get politically active. Fiscal problems for docs are only going to get worse until the SGR is repealed, he says.

For many Americans struggling in a down economy, it's tough to sympathize with physicians simply because of their earning power. The median annual salaries for physicians range from $174,000 for family practitioners to $225,000 for surgeons, according to the Bureau of Labor Statistics. For many physicians, however, the continual hassle over the doc fix is wearying.

A baby-boomer physician, who holds a medical directorship at a healthcare facility, told me of his disgust with the health system, what he sees as misleading cuts, and the floundering of the American Medical Association in lobbying. He didn't want to be identified so he could speak freely.

"I think it was about '87 when Medicare started cutting us or certainly not giving but a token increase," he says. "That was the year I made the most and it has been downhill since. You cannot make a living seeing patients. We are regulated and cannot raise any prices."

"How can you make it when you cannot charge more but our costs go up every year?" he adds. "Remember, we are a small business, but we are totally at the whim of the government. The government jerks you around every few months and I mean every few months. They always talk big cuts so when they do smaller ones, it looks like we got a great deal."

Interestingly, there are 20 physician members of the 112th Congress, including three senators, 16 representatives, and a delegate. None of them are considered leaders of the doc fix debate, and their presence seems to have no impact on this physician issue—or others.

The AMA itself has spent much of the past two years lobbying to abolish the SGR, with so far little to show for it. Gilberg points to two House members, Rep. Allyson Schwartz, D-PA, and Rep. Phil Roe, R-TN, who are working for change. Schwartz and Roe issued a statement saying they continue to garner bipartisan support to repeal the SGR.

Generally, physician lobbying groups have failed to make true inroads to get doctors' voices heard in Washington D.C.

At best, the politicians talk about fixing the SGR but don't do anything except apply an annual band-aid. And the clock to 2012 is ticking.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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