Volume not docs' fault
Todd Sloane appropriately is critical of current Medicare formulas, but is inappropriate in his choice of words concerning Medicare costs generated by physicians ("One reprieve, strings necessary," Oct. 9, p. 20). I manage a broad cross section of physicians, and I do not see physicians treating Medicare patients as if they are "automatic teller machines."
It is true that Medicare expenditures for services are increasing at a faster pace than private insurance, but please look at the population served and the increase in preventive benefits extended to Medicare patients. Case finding, acuity and the increased longevity of a growing older population has increased the need and demand for services, which of course will generate more costs compared with private health insurance.
Sloane's reflection on pay-for-performance programs also seems off-base. P4P programs do not just reward high achievers. We see in our independent practice association and in the P4P programs in California an improvement in performance. The bar for each criterion keeps being set higher because of increased performance, which pulls all providers up.
Also, Sloane believes that P4P might tamp down the increase in the volume of service. I do not think so. When you couple disease management programs to P4P services -- be they preventive, acute or chronic -- care-will see increasing volume, at least in the short run. The hope is that better disease management will postpone the acute phase, prevent a disease or mitigate the needs in the chronic disease state. Furthermore, patient satisfaction is a huge part of P4P and that typically means patient access when they want it, which can drive up encounters.
This is a critical time to address payment mechanisms and assurance of quality care but not at the last hour of the congressional session, when this important and complicated issue cannot possibly get the attention it deserves. The government has known about the flawed Medicare physician compensation formula for years and it is time to fix it, by next year, and not penalize the providers with a pay cut based on flawed formulas this year.
Avram KaplanExecutive directorSaddleback Physician ServicesLaguna Hills, Calif.