Paying doctors more money is a tough sell even in the best of economic times. The public and its elected officials perceive physicians to be some of the wealthiest people among us regardless of what the data say. Add in the recent recession and the debate over spending almost $1 trillion on national healthcare reform, the $250 billion bill to fix the way Medicare pays doctors was a long shot, if not dead on arrival, in Congress.
The first nail in the bill's coffin was its rejection in the Senate last week. Physicians should not expect to be treated any better in the House, if it ever comes up for a vote.
The American Medical Association should have seen this coming, but it decided to trust the White House. The AMA was one of many organizations and industry sectors that cut a deal with the Obama administration. Most of them agreed to make some level of financial concession in exchange for supporting a reform proposal that wouldn't be potentially fatal to that particular sector of the industry. Pay up and you'll live. Don't pay and we'll figure out a way to put you out of business.
For its part, the AMA agreed to support President Barack Obama's reform plan in exchange for the passage of a bill that would scrap the current way Medicare pays doctors for care to beneficiaries, and freeze payment rates for 10 years until a new, more equitable payment system would be put in place. But you didn't hear or see Obama stumping for physician payment reform as aggressively or as overtly as he has for his overall healthcare reform plan. Perhaps he knew physician payment reform was a dead issue, and he didn't want to waste any political capital that he needs for the bigger fight.
Now what's the AMA to do? We would suggest turning its sights on the fatal physician-ownership provisions in the five reform bills pending in Congress. The provisions effectively would put physician-owned hospitals out of business. They would not allow existing facilities to expand. They would not grandfather-in facilities under development. And they would not allow new facilities to be built.
Physician-owned hospitals do wonders for local healthcare markets by adding much-needed competition to those markets. But they also give entrepreneurial doctors an opportunity to control their own financial fate. If the government isn't going to pay them any more money for treating the poor and the elderly, at least let them own their own business just like every other American has the right to do.
The AMA would be wise to work day and night to strip those reform bills of those provisions and do what it can for its members rather than hoping for something that may never happen at all.
David BurdaEditorModern Physician
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