On Wednesday, Nov 17, the AMA is urging physicians to call their congressional delegation to beg for another reprieve from the scheduled Medicare fee cut. This game of “chicken” has been going on for 8 years now. http://www.aapsonline.org/newsoftheday/001097

AAPS consistently sends a better message: Never mind the “sustained growth rate” (SGR). Do away with the price controls—the ban on balance billing.  Allow patients and doctors to contract privately, without government interference.

We know that Medicare is insolvent. It will be cutting payouts because it has no money. But it does not have the constitutional authority to deny seniors access to care.

Medicare has the power to determine reimbursement any way it likes. Currently it uses the values set by the 29 members of the powerful, secretive RUC (Relative Value Scale Update Committee), which is convened by the AMA. These Solomons determine how to divvy up the $60 billion that Medicare spends on physicians’ fees. Then the government sets the “conversion factor” in an effort to determine total outlay.

But the federal government should not be dictating fees. Only patients and doctors can determine a fair fee that will allow the doctor to keep his office open so his patients can continue to receive care.

We agree with the AMA on one thing: physicians should be re-evaluating their Medicare status. Finally, the AMA is making its members aware of the possibility of opting out. (AAPS is the number one site for information on how to do this.)

We suggest you call your Senators and Congressman (the Capitol switchboard is 202-224-3121) or find your Congressman’s and Senators’ contact information at http://www.contactingthecongress.org/.

Tell them that Congress should:

• Free patients from the price controls that are destroying their access to care. Doctors should set fees; Medicare should only set reimbursement.
• Never mind the SGR. Eliminate the ban on balance billing and the penalties for charging a fee different from the one calculated by CMS.
• Allow unrestricted private contracting outside of Medicare.
• Be aware that if Congress does not act, you will (opt out of Medicare; stop seeing Medicare patients, cut certain services, retire, etc.).

Note that this Wednesday will also be the first time that new CMS head Donald Berwick, M.D., will appear before Congress. He will testify before the Senate Finance Committee, which will hold a hearing on the effects of the Affordable Care Act (ACA or ObamaCare) on seniors and consumers.

By Jane M. Orient, M.D.

Nine times in the past eight years, Congress has, at the last second, delayed the automatic cuts in doctors’ Medicare fees that it decreed some 13 years ago to prevent Medicare spending from outpacing other consumer expenditures.

The AMA threatens that doctors, especially primary care doctors, will stop accepting Medicare patients if the cuts go through. Congress cites the impending bankruptcy of the program.

Every time cuts are postponed, the next scheduled cut gets deeper. It’s like a balloon mortgage payment in reverse. Continue reading →

by Jane M. Orient, M.D.

All eyes are on the BP gusher in the Gulf, spewing pollution over the shoreline, but there’s another big leak that will do even more damage to our economy: the one in the Medicare well. 

Ever since 1965, when Medicare was enacted, the federal Treasury has been hemorrhaging dollars. Previously, “10%” was quoted and re-quoted as the amount of fraud. More recently, Senator Tom Coburn (R-OK) alleged it to be 20%.  

Like BP’s oil containment dome, previous efforts failed to plug the hole. Despite hundreds of millions of dollars shoveled into the Health Care Fraud and Abuse Control Program (HCFAC) by HIPAA (the Health Insurance Portability and Accountability Act), federal prosecutors say they need still more “resources” and “tools.”   Continue reading →

AAPS member and director, Juliette Madrigal-Dersch, M.D. was featured in a spot on the NBC news yesterday talking about her decision to opt-out of Medicare.  The 21% cut in Medicare reimbursement that again went in to effect on June 1 is leading a growing number of physicians to consider this option.

However most doctors who opt out say it is not because of the money, Dr. Madrigal’s fees are less than the price of a haircut and she sees patients over 90 and cancer patients for free.  She once again has the freedom to see her senior patients without the Medicare bureaucracy looming over her shoulder.  Her patients are happier and so is she.

Dr. Madrigal will be a featured speaker at the June 25th AAPS workshop, “Building a Healthy, Independent Practice” to be held in Atlanta.  Visit www.aapsonline.org/atlanta for more details.