Doctors: Damned If They Do, More Damned If They Don't
Americans worried that Obamacare will lead to de facto rationing of health care to senior citizens can stop worrying. It's already here. Obviously, the fewer doctors willing to treat Medicare patients, the fewer the opportunities to get treated and with each passing year, the number of such doctors decreases.
Early this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn't know any -- and that if Ms. Plumb found one she liked, could she call and tell her the name?
"Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician's resource use is at or above the 90th percentile of national utilization." Translated into plain English, it means that in any year in which a particular doctor's average per-patient Medicare costs are in the top 10 percent in the nation, the feds will cut the doctor's payments by 5 percent.[...] This provision makes no account for the results of care, its quality or even its efficiency. It just says that if a doctor authorizes expensive care, no matter how successfully, the government will punish him by scrimping on what already is a low reimbursement rate for treating Medicare patients. The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. And because no doctor will know who falls in the top 10 percent until year's end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties.
- 1. Order every test and treatment deemed necessary for the patient and/or to protect the doctor from a potential lawsuit (defensive medicine) and increase the chance of vaulting into the dreaded 90th percentile and getting his already-low Medicare payments docked an additional 5% (and remember: by definition, 10% of doctors will wind up in that percentile); or
- 2. Eschew a test and/or treatment to reduce his billings in an effort to stay out of the 90th percentile and increase his chances of being sued if it turns out that he should (or a sharp trial lawyer can convince a jury he should) have provided.