Regarding “MedPAC lists cuts to save $233 billion,” ModernPhysician.com, Sept. 21: It is sad that the Medicare Payment Advisory Commission's “doc fix” includes an indiscriminate across-the-board freeze for primary-care services and an annual indiscriminate across-the-board decrease in specialist services.

Why do they continue to put forth reimbursement fixes that address over-served and underserved areas of the country equally? It's mind-numbing! A better way would be to address reimbursement for specific services and to address what has been described as “artificial demand creation.” Less objection, higher quality medicine and better economic results!

Michael Samms
CEO
Enable Quality Health
Overland Park, Kan.

Re: “Few spared in consultant's review of healthcare scene,” ModernPhysician blog, Sept. 23: Hospitals now have the upper hand in physician practice acquisitions. More than 50% of physician practices are now owned by hospitals. The percentage has increased dramatically over the past two years with a game-changing attitude shift by physicians.

The real work is not in negotiating the deals, but in ensuring accountability, quality and productivity with a financially rewarding outcome to the acquired physicians in the practice who become salaried employees and a return on investment to the entity purchasing the practice.

There are five prime reasons to consider integration. Unless a physician or a multiphysician practice can realize a net gain in at least two of them, the probability of a successful and mutually rewarding transaction is low. The five key components are: infrastructure economies of scale (documented cost-savings), increase in managed-care contract reimbursement, group purchasing advantages, malpractice premium reductions, and complementary services.

Emotional integration for the sake of “just doing something” is never a good reason to act. With one-third of practicing physicians age 55 and over—more than 250,000 physicians—this is a subject of increasing frequency and concern among physicians all over the country looking for an exit strategy and a way to monetize the goodwill in their practices from, in many cases, over 25 years of business and dedication to their patients.

A. J. Rosmarin
Rosmarin Consulting
Dallas

Re: “Fee-for-all,” (Sept. 12, p. 6): The issue is not merely transparency but what to do with higher physician costs. Since prices for all healthcare products and services are higher in the U.S. than in other developed countries (except generic and over-the-counter medications), the one solution coming from Congress and other healthcare reformers is: Save money by lowering prices. However, decades of research studies from this and other countries clearly demonstrate that lowering prices does not lower overall cost. If fees are reduced, physicians increase the volume of services and level of technology. But reducing volume and technology is rationing—or at least more informed use of products and services.

Policymakers need to realize that although physician payments account for 20% of healthcare costs, what we order results in 80% of our annual healthcare bill. Reform will never occur without a systemic reconstruction, aligning incentives of all segments of the healthcare field and delivering evidence-based medical care.

The real question that remains: Is the public willing to accept these changes?

Dr. Joel Shalowitz
Northwestern University
Evanston, Ill.