This seems like it should be good news for physicians…
Physicians will get a 0.5% pay increase each year for 5 years under a deal by a bipartisan team of House and Senate negotiators to repeal the sustainable growth rate (SGR) formula for physician payment under Medicare.The part that caught my eye was
The bill provides a 5% bonus to physicians who receive at least 25% of their Medicare revenue from an alternative payment model in 2018. Alternative payment models include accountable care organizations, patient-centered medical homes, and others. The 25% threshold increases over time, according to the summary.I looked up "alternative payment models" under the ACA, and found this.
Risk-based arrangements (i.e., budget-based contracting) payments are predicated on an estimate of what the expected costs to treat a particular condition or patient population should be. This includes capitation, bundled payments, and shared savings arrangements….The onus is on the physician to be able to manage expected utilization and related practice expenses for treatment. Success is based on the practice’s ability to control the health care expenses of the patient population so that they do not exceed the budgeted amount.That seems a bit similar to the budget limits proposed under single payer.
Global operating budgets for hospitals, nursing homes, allowed group and staff model HMOs and other providers with separate allocation of capital funds.I'm not sure if my perception of a similarity between these two proposals is correct. From the original article:
The proposed system entails an unprecedented degree of healthcare micromanagement by the federal government, according to David Howard, PhD, health policy professor at Emory University in Atlanta.I wouldn't call single-payer micromanagement of healthcare by the government. Of course the ACA is not anywhere near single-payer, but maybe the 5% bonus can get doctors to gradually get used to moving in that direction.
On a related note, in a recent article in the New England Journal of Medicine, Dr Casalino from Cornell suggests that we should "ask all physicians to commit to providing care for enough Medicaid enrollees so that at least 5% of each physician's practice consisted of Medicaid patients."
The problem I see with this idea is that it suggests if we commit to some arbitrary percentage of medicaid patients we would take, we have then fulfilled our professional and moral obligations. The Hippocratic Oath doesn't say we can comply just 5% of the time. A 5% campaign would send the message that the Oath is negotiable. Physicians should acknowledge that they are plenty well off accepting Medicaid/Medicare patients (especially as specialists), and should be reminded of the commitment that they already made when they chose to pursue the medical profession.
The good news is that according to a report (pdf) from the department of Health and Human Services, the trend of physician acceptance is in the positive direction for Medicare. Unfortunately Medicaid payments are on the average about 60-70% of Medicare payments (although in some states they are even higher than Medicare). Instead of a 5% campaign, maybe we need to have a campaign to increase Medicaid payments, or better yet, extend Medicare/Medicaid to all citizens.
"Relying on the pure goodness of physicians will not work because there are not enough so oriented to meet the need."I would like to think that is not true. If it is, it is a sad commentary on our profession. I wonder, at what point do we start to consider other people's problems as our own, and ask "is this the type of society I want to live in?"