Americans understand that the legislative process is a lot like watching sausage being made-messy and not especially appetizing. But there's growing concern that the Republican plan to reform Medicare smells like an inordinately sweet deal for one well-heeled interest group: America's physicians.
House Republicans may have crossed the line when they bought support for their reform plan from the American Medical Association by agreeing to reduce the physician fee cuts originally specified in their reform plan. The deal was the culmination of negotiations that put the financial interest of doctors ahead of those of the public and the rest of the healthcare community.
What makes the GOP's promises to physicians suspect is that Republicans still expect to achieve large savings from Medicare-as much as $270 billion. The deal that reduces by about $700 million the planned $26 billion cut in payments to doctors means an extra hit for other provider organizations.
Other tasty morsels for physicians would:
Significantly weaken federal laws prohibiting fraud and abuse in Medicare and Medicaid.
Allow physicians to refer Medicare patients to medical equipment suppliers and other companies in which the doctors have a financial interest. Such referrals are now forbidden by law.
Eliminate most federal regulation of medical laboratories in physician offices.
Institute medical malpractice reforms that will make it more difficult to win judgments against poor quality care.
Provide unneeded-and potentially dangerous-antitrust relief for doctors developing integrated networks.
While healthcare executives could easily support some of these provisions, collectively they are cause for concern. Especially troubling would be overturning physician self-referral provisions that were implemented under the "Stark I" and "Stark II" laws and relaxing antitrust requirements.
Under the Stark laws, named for sponsor Rep. Fortney "Pete" Stark (D-Calif.), physicians cannot adopt group practice compensation arrangements that are based on the volume or value of referrals made by the group's physicians. Eliminating such referral bans will make it easier to disguise the intent behind kickback arrangements and make prosecution of questionable activities more difficult.
Relaxing antitrust provisions invites the fox into the henhouse. As reporter Jonathan Gardner reports on p. 34 of this issue, the plan would allow physicians who are not part of a risk-sharing network to discuss fee schedules they are negotiating with newly created Medicare provider-sponsored organizations. The proposal also exempts from antitrust lawsuits several types of medical self-regulatory bodies including state and local medical societies and hospital medical staff peer review organizations that set and enforce healthcare quality standards.
In the name of quality, such exemptions could insulate regulatory bodies from lawsuits even in cases that might involve financial gain, such as excluding or boycotting competing providers in an effort to keep competitors from getting a foothold in markets.
Physicians, like other providers, profess that all they desire is a level playing field, not one tilted in their favor. Congress should take them at their word. Giving physicians everything they want not as a matter of policy but as a sweetener to sell reform is a dangerous game that will only come back to haunt Republicans.