By now you should all be familiar with the “Super Committee” created in the deal President Obama and Congress struck to raise the nation’s debt ceiling. This committee is scheduled to produce at least $1.2 trillion in Federal spending cuts over the next decade due the day before Thanksgiving 2011. If they are not able to reach a consensus or if the Congress does not approve their package by December 23, 2011, a series of automatic spending cuts kick in by 2013. So what does this mean to physicians, hospitals, and most importantly their patients? Although Medicare & Medicaid are protected in the short-term there is a second round of funding cuts called for in the law. Basically if Congress doesn’t agree on a debt plan and cuts are triggered, beginning in 2013 there would be a 2% reduction in Medicare payments to hospitals and other providers (that’s us). I’m often asked; “what makes this different from the Simpson/Bowles spending cuts recommendation”? Basically, the difference is if Congress doesn’t act there is an automatic trigger to cut spending giving a much higher level of seriousness to Congress to do their job.
Currently Medicare & Medicaid make up approximately 23% of Federal spending and their costs are growing faster than the overall economy. The reasons for this are obvious with are aging population, and increased utilization. I always like to insert here; …and the complete lack of any meaningful tort reform.
In addition to the proposed possible 2% cut if Congress doesn‘t act, there’s the sustainable growth rate (SGR) that has never yet been permanently addressed. Medicare is scheduled for a 30% cut to physicians pay at the end of this year. Although these cuts keep getting kicked down the road, year after year, it is estimated that a one year “fix” would cost $25 billion. The American Medical Association as well as the American Society of Nephrology and the Renal Physician Association all are pressing for a 2 year fix costing approximately $50 billion. This fix adds and complicates the work of the Super Committee as it will be additionally “unanticipated” spending.
So what’s a doctor to do? As with many things in Washington the “squeaky wheel will get the grease”. If you’re cynical or have been broken by the system, then, in the words of National Lampoon’s famous parity on fraternity life, Animal House; “thank you sir, may I have another” may be your initial response. But for those optimists out there, those championing the interests of their patients; those who understand that the baby boom population is peaking and will decrease over the next 10-15 years; those who believe that physicians are a major part of the solution and not part of the problem; then pick up your phone, insist on speaking with your Congressional representative and share with them the realities of caring for patients in your communities. Be specific. Let them know what you deal with every day including the changing landscape of hospital/physicians relationships, implementation of EMRs, the continued open season by the trial lawyers, and many of the other challenges all placing barriers between you and your patients. This is about your ability to provide care to your patients and your communities. If you are silent we all know the outcome. Pick up the phone today and let your voice be heard!
I look forward to your comments,
Robert Provenzano, MD
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