With the alarming shortage of primary care physicians facing the United States, one has to wonder if Nurse Practitioners and PAs are going to represent the new Primary Care providers.  This is already one of the fastest growing segments of the healthcare industry and with the continuing shortage of family practice, internal medicine, and pediatricians, one can assume that it will not be changing anytime in the near future.

What is the answer to the shortage?  Well, some say more money but how much more and how do you force the commercial insurance industry to comply with standards adopted by Medicare.  There currently is no regulation specifically requiring commercial insurance companies to follow the guidelines produced by CMS.  So even if CMS does what many have suggested and increase the physician fee schedule for Medicare, what makes anyone believe that commercial insurance carriers are going to just fall in line.

I hope for the sake of our healthcare system that we come up with a solution fast or we are going to be in for a rude awakening as the wait times and locations continue to dwindle.

Paying for payment reform

The House-passed Medicare physician payment reform bill would cost the federal government an estimated $210 billion over 10 years. Nearly $260 billion in higher pay would go to physicians and health plans to treat seniors and military members over that time. But beneficiaries would make up roughly $50 billion of that through higher premiums.

Source: Congressional Budget Office Cost Estimate on H.R. 3961Medicare Physician Payment Reform Act of 2009, Nov. 4 (www.cbo.gov/showdoc.cfm?index=10704)

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Senate plan for reform

Senate Democratic leaders unveiled their version of a health system reform bill Nov. 18, and the full Senate will begin debating the measure when lawmakers return from their Thanksgiving break. The bill would extend coverage to an estimated 94% of Americans at a projected cost of $848 billion over 10 years. It also would cut the deficit by an estimated $127 billion in its first decade. It includes proposals for:

• State health insurance exchanges by 2014 that residents could use to obtain coverage.
• A public health insurance option that allows individual states to opt out of participation.
• A requirement that most individuals obtain coverage by 2014 or pay a penalty.
• Affordability credits for those earning up to 400% of the poverty level.
• Medicaid eligibility expansion to 133% of the poverty level.
• New health insurance coverage and market reforms.
• Replacement of the 21.2% Medicare physician fee cut in 2010 with a 0.5% increase.
• A 40% excise tax on “Cadillac” health plans, as well as additional fees on health plans, hospitals, and drug- and device-makers.
• Higher Medicare payroll taxes for higher-income workers.
• A 5% excise tax on voluntary cosmetic surgical and medical procedures.
• A Medicare ban on new physician-owned hospitals.
• An extension through 2014 of the Medicare Physician Quality Reporting Initiative.
• A new federal Center for Medicare and Medicaid Innovation to test alternative payment and delivery models.
• A national, voluntary Medicare payment bundling pilot program.

It also includes more help for Primary Care in the form of an additional 1% over GDP.  The House Medicare pay bill sets a new spending growth rate target for physician services that would be equal to the gross domestic product plus 1%. Preventive care and evaluation and management services would have a separate target of gross domestic product plus 2%, allowing primary care pay to increase at higher rates over time.

Source: The Patient Protection and Affordable Care Act

It is important to note that this bill is unlikely to pass the senate in its current format.  We should know what the Senate will do in the next couple of weeks as they should finish before the Christmas holidays.

Is anyone else confused at the position of the American Medical Association regarding ObamaCare?  It would seem as though they are a very poor representation of their members.  But the fact is that the recent house bill has thrown huge incentives at Physicians by doing away with the SGR (Sustainable Growth Rate Formula) which was due to give physicians a 21.5% decrease in Medicare payments in January.  It has been coming up with decreases every year for the past 4-5 years but every year it is stopped by the AMA or other lobbyists.  Anyone practicing Medicine knows that the Medicare reimbursements are barely enough to cover the costs of doing business so any cut to Medicare would be far felt.  The doing away of the SGR is a big win for the AMA so it does not surprise anyone when they offer their support.  The House bill also contains an allocated 5% increase to primary care physicians(Finally) which has been needed for a long time.

The problem with the AMA’s support is that the Bill still is devasting to our national deficit and long term sustainability.  With a Medicare system that has been operating in the Red for years, how can we expect the government not to come up with a balance that debt in the coming years.  What you will have is a healthcare system revolving around the government.  40% Medicare, 60% obamacare.  The House bill does provide some serious incentives but you have to question the naked man who offers you his coat.