Medicare reform more palatable as stew, not sausage

AMA Leader Commentary. By Richard F. Corlin, MD. May 20, 2002.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from AMA President Richard F. Corlin, MD.

Congress has before it a full plate of issues to deal with -- all related to Medicare. Among those issues:

Medicare payment update: The AMA and other physician groups continue to wage an effective campaign to stop the outrageous physician payment cuts. The good news is that The New York Times recently reported that "Many lawmakers say their top priority is to increase Medicare payments to doctors." Congress cannot and will not allow cuts of nearly 20% over four years to occur.
Regulatory Relief Act: Simplifying Medicare regulations, as well as putting in place both due process rights for physicians and a sense of fairness in conducting audits of physician offices, remains an essential task. The Regulatory Relief Act also contains requirements holding the carrier-intermediaries to the terms of their contracts, requiring them to give physicians correct answers to billing and coding questions, and then following up with written confirmation of those answers. (Think about this -- a recent investigation by the Dept. of Health and Human Services Office of the Inspector General found that the carrier-intermediaries administering the Medicare program answered even their questions right only 15% of the time.)
Pharmaceutical benefits: This issue has been gaining great popularity with the public. Balancing patient needs and fiscal responsibility requires Solomon-like judgments.

These are indeed difficult and complex issues. Any one of them is more than enough to occupy this whole column, as well as the full attention of both houses of Congress. And contained within each of them are questions both big and small that require long and careful consideration by our legislators.

Congress and the administration must avoid the old game of "overpromise, underfund and shift the blame." Physicians and the entire health care system have been victimized for far too long by inadequate financing and unfunded mandates.

New Medicare outpatient prescription drug coverage should be administered as a distinct benefit, not as part of either Part A or Part B, so that we can accurately track pharmaceutical spending and adjust premiums and federal funding accordingly. The drug benefit must be designed with some form of mandatory feature, so as to guard against adverse selection. The benefit also must not provide incentives for insured patients to drop their private coverage and move to the new federal program.

In addition to stopping the outrageous payment cuts, Congress should change current rules that require physicians to participate in Medicare on an "all-or-nothing basis," regardless of our patients' income or wealth. Physicians should have the freedom to decide, on a patient-by-patient basis, whether services are rendered under a "private contract" or subject to Medicare payment limits.

The final Medicare bill that is signed into law later this year will be just the first step toward correcting flaws in the program. Additional work will be needed over the next several years to deal with the oncoming wave of baby boomers who will soon become eligible for Medicare benefits.

Some groups may register complaints about the shortcomings of the final Medicare package this year. We cannot, however, allow the perfect to be the enemy of the good. Those who hold out for perfection will be saddled with the status quo. The AMA will make every effort to secure passage this year of long-overdue Medicare reforms.

As for "stew or sausage?" I would like this bill to be like a good stew, rich and fulfilling with many separate, identifiable ingredients, each of which adds to the flavor of the finished product. What I don't want is a sausage, of indiscriminate animal parts and of questionable heritage, which tastes only of its seasoning.

Dr. Corlin, a gastroenterologist in private practice in Santa Monica, Calif., served as AMA president during 2001-02.