• Can the government stick it to the docs?

    Most of Bruce Bartlett’s first Economix post summarizes the state and future of Medicare and Social Security finances. I did not predict where he would end up, with an endorsement of the idea of no doc fix. None.

    Medicare’s actuaries do not believe their own projections are realistic because they were required to assume that a key provision of current law will take effect as scheduled. […] It would require a 29.4 percent cut in fees for doctors who treat Medicare patients on Jan. 1, 2012. […]

    [W]hat if President Obama and House Speaker John Boehner agreed, as part of negotiations on raising the debt limit, to let the this cut in Medicare fees take effect as current law requires? […]

    The doctors will scream bloody murder and threaten to stop treating Medicare patients. It will be ugly. […]

    I think if he and Mr. Obama jointly committed to not to implement another so-called “doc-fix” — the delay in cutting Medicare fees — it would be a solid first step on finding a bipartisan approach to dealing with the deficit.

    Is this even thinkable? Bartlett just suggested it is, to which I can only say, “Wow!” or, maybe more appropriately, “Yikes!”

    LATER: I should add that if Congress could stick to a no doc fix deal then we should not be skeptical of it sticking to anything. This is as politically challenging as it gets.

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    • Sure it’s possible . . . if you can identify 218 Congressional districts and 26 states that don’t have any physicians (maybe those are simply the states that haven’t yet enacted malpractice caps causing 100% of their docs to flee to Texas).

    • Suppose Medicare payments to doctors were cut as prescribed in current law.

      1. How would doctor incomes then compare to those of other OECD countries?

      2. Could doctors maintain their current incomes by refusing to accept Medicare patients — that is, would the population of non-Medicare patients be large enough to sustain doctors’ income?

      On the other hand, in the realm of high-income occupations, I believe that doctors are more “deserving” of their incomes than most.

      • Economic theory would predict that in order to entice more non-Medicare patients (or, really, patient-visits and patient-procedures), physicians would have to accept lower, not higher payments. This is especially true in a climate of increasing cost sharing. I don’t see how incomes stay put if Medicare fees are whacked substantially. It really would be a pay cut, even if beneficiaries lost access.

    • The tightening of access to providerst (polite speak for for how many new providers drop Medicare) is dependent on how the CMS has valued them in the past in the Relative Value Unit system. Invasive cardiologists have a higher RVU than family practice docs. Medical neurologists have a higher RVU than psychiatrists. (I know those are not 2 fair sets of medical specialties to compare.). However, taking 29% off of losing money to see a Medicare patient versus bringing Medicare rates down to breaking even to see a Medicare patient makes a big difference to the actual provider. To family practice, internal medicine and psychiatry (among others?) Medicare is no way to support a practice–especially without E&M codes–so you must be talking about some rarefied big brained specialists….