The American College of Surgeons, a group representing 200,000 doctors in 20 surgical specialties, says it will fight health reform as proposed by the Senate Finance Committee, because "it will make an already-flawed system worse" in six ways.
A. Brent Eastman, MD, chairman of the ACS Board of Regents, emphasizes that the doctors are not opposed to health reform per se, and supports changes to provide cost-effective, high-quality care.
But "too many of the provisions that the Senate Finance Committee considered put patient access and quality improvement at risk," says Eastman, who also a trauma surgeon and chief medical officer at Scripps Health in San Diego.
He made the statement yesterday on behalf of 19 other professional societies, including anesthesiology, colon and rectal, endoscopic, gastrointestinal, neurology, obstetrics and gynecology, ophthalmology, orthopaedic, osteopathic, plastic, urology, and vascular surgeons. Their objections were sent in a letter yesterday to Senate Majority Leader Harry Reid.
"This is the first time you're seeing a large group of physicians, surgical organizations stand up" to oppose this, says Christian Shalgian, ACS' director of advocacy and health policy. Though ACS has sent six or seven letters over the last year expressing objections as health reform language began to take shape, "our concerns have been quite frankly ignored."
Eastman stresses that the doctors are not opposed to health reform, and favor the recently released proposals in H.R. 3962, the Affordable Healthcare for America Act, as well as the Sustained Growth Rate formula fix, H.R. 3961.
But the groups are opposed to the Senate proposals because they contain the following six provisions:
1. It would mandate that all physicians participate in Medicare's "seriously flawed," Physician Quality Reporting Initiative, and penalize those who decline. The PQRI program, which was launched for voluntary physician participants in 2006, calls for doctors to submit quality data on how they provided 100 types of care, such as whether appropriate antibiotics were administered prior to surgery.
In exchange for volunteering the information, the doctors were to receive bonuses in their reimbursement.
However, after CMS told doctors to send in their quality data, and after doctors faithfully followed the instructions, CMS "acknowledged that the instructions were wrong; that they had made mistakes, and that they would fix the problem and come back to doctors with a clear set of instructions," Eastman says.
"That was in 2007—we are now almost to 2010—and we still haven't heard from them what that clear set of instructions are supposed to be. And now the Senate want to mandate that we participate in the program?" says Eastman.
He adds, "This doesn't make any sense, and it certainly won't improve quality."
"They would go the whole year submitting their data, but never got the bonus payments," adds Shalgian. "They'd contact CMS, which said the doctor 'didn't participate appropriately, didn't send in the right information or sent it in on the wrong form.'"
Additionally, Eastman and Shalgian, say that participating physicians have received little, if any, of the bonus payments that were promised.
Officials for CMS were asked to respond Wednesday, but press officer Joe Kuchler says they could not comment on the accusations on such short notice.
2. Under the Senate plan, Medicare would give 10% bonus payments to primary care and family physicians as a workforce incentive, but half of that bonus would be financed by cuts in surgeons' pay. This would have an especially discouraging impact on the workforce of surgeons in underserved and rural areas.
3. The Senate plan would reduce payments to doctors who have the highest utilization of procedures "without regard for patient acuity or complexity."
4. The Senate proposal would establish an independent Medicare Commission whose decisions would become law without a separate vote of Congress. These individuals would not be elected, and would have no accountability to the public, yet would get to decide what treatments or procedures would be reimbursed under Medicare and which ones would be categorically denied, Eastman says.
5. The Senate plan would establish a budget-neutral value-based payment modifier, which CMS does not currently have the capability to implement. It also would place the provision on an unrealistic and unachievable timeline.
6. Under the Senate proposal, physicians would pay a fee to cover a background check in order to participate in Medicare, despite the fact that doctors already pay fees for training, licensure, and board certification.
Eastman sums up the groups' adamant objections, saying: "We are 100% behind quality improvement—it is our heritage and a constant focal point for surgeons—but it is foolhardy to mandate an unsuccessful program."