Doctors balk at Senate attempt to cut waste

October 28, 2009

The big goal of health care reform is to cut out wasteful spending in order to pay for expanding health insurance coverage.
But some doctors say the way the Senate Finance Committee bill tries to do that would be disastrous.
The bill would require all physicians to participate in Medicare’s Physician Quality Reporting Initiative by 2012 and then, in 2014, use those reports to cut Medicare reimbursement by 5 percent for any doctor whose level of testing and procedures is in the top 10 percent of all doctors in his or her field.
The concept of the bill is good, said Dr. Pete Sallay, managing director of Medicine Sports Medicine in Indianapolis, but the execution is bad.
“I guarantee you, if you try to do this on a national level, it will be disastrous,” said Sallay, an orthopedic surgeon who focuses on shoulder reconstruction. Other physicians around the country also have voiced concerns over the provision.
They worry the government will not be able to collect the data needed to make sure the new law doesn’t punish doctors who do lots of tests and procedures because they see the sickest and poorest patients.
“People aren’t widgets. So you can’t make broad sweeping generalizations,” Sallay said.
The Senate Finance bill calls for the Medicare program to collect health status and demographic data to account for those differences. But in the past, the government has acknowledged that it has been unable to do so adequately.
Health insurers have tried and failed to do the same, noted Stacy Cook, a physician attorney at Barnes & Thornburg LLP in Indianapolis.
“It's just something that's extremely difficult,” she said. “It's something that I don't think has successfully been done.”
A better way to go, Sallay said, would be to change payment models to reward groups of local physicians for reducing costs.
As an example, he noted Clarian Quality Partners. It’s a nascent network of independent physicians signing agreements with the Indianapolis-based Clarian Health hospital system pledging them to work with other Clarian physicians toward improving communication with doctors and overall patient outcomes.
Clarian, which is only one of several hospital systems pursuing this strategy, hopes the network of doctors can then negotiate contracts with insurance plans that would give it bonus payments based on its success at improving quality and reducing costs.
That could include the Medicare insurance plan, if Congress gives it freedom to enter such arrangements. Health reform legislation in the House includes limited pilot programs to allow Medicare to share the savings from improved quality with hospital-doctor groups.
But if Congress instead instructs Medicare to cut payments for overulitization, Sallay says doctors have no faith it will do it right.
“Are you kidding me? No way are we going to trust the government to make a right decision about this,” he said.


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