What is it about doctors and money that gets everyone so worked up? Should physicians work for free because healing the sick and injured is reward enough? Or can you never pay physicians enough for what they do for mankind? What's fair, of course, is somewhere in the middle, but the tug-of-war over where the “middle” should be is getting pretty intense.
Beyond just doctors
Payments to physicians always arouse interest, but others deserve scrutiny too
Pulling on one end of the rope is the American Medical Association, which last week again reaffirmed its support for the healthcare reform bill passed by the House. The AMA is supporting the bill in exchange for support from reform-minded legislators and the White House for a bill that would fix the way Medicare
currently pays physicians for treating beneficiaries. Without action by Congress, Medicare payments to physicians are set to drop by 21.2% on Jan. 1. The bill, which the Congressional Budget Office estimated would cost $210 billion over 10 years, was defeated 53-47 last month in a procedural vote in the Senate. But despite getting burned once, the AMA again is going to bat for the House bill and for the president in the hope that another vote on Medicare payment reform for doctors will go its way.
Pulling on the other end of the rope is the hospital lobby led by the American Hospital Association. The AHA and the Federation of American Hospitals want to stop physicians from owning their own hospitals, which cuts into their members' business. The original three House bills effectively would have put physician-owned hospitals out of business and taken a big chunk out of the wallets of those physician entrepreneurs who dared to want to own their own healthcare business. Provisions in the three bills would have barred existing physician-owned hospitals from expanding; would not have grandfathered in physician-owned hospitals under development; and would not have allowed any new physician-owned hospitals to be built. The provisions made it into the House-passed bill, but the bill included an exemption from the restrictions for physician-owned hospitals that treat more than their fair share of Medicaid patients (Nov. 9, p. 8).
In the middle are individual hospitals, physicians and others trying to feel their way through but who often run afoul of public opinion if not the law as they try to compensate doctors for what they believe are legitimate services. As the rash of recent settlements attest, the federal government is cracking down on alleged illegal kickbacks to physicians for patient referrals. The most recent was the $27.5 million Universal Health Services paid to resolve allegations that it disguised bribes-for-patients as generous lease arrangements and medical directorship positions (Nov. 9, p. 12). Since July, 10 other hospitals have entered into similar settlements involving various financial arrangements with physicians (Oct. 12, p. 6).
Then you have all the scrutiny over drug- and device-company payments to doctors for everything from speaking engagements to continuing medical education to clinical research to journal articles. That scrutiny is shoving a lot of money-changing between commercial interests and practitioners into the light. Last month, for example, drugmaker Merck & Co. began posting online the speaking fees it paid to doctors and other medical professions. Merck said it paid a total of $3.7 million in speaking fees to 1,078 people from July 1 through Sept. 30. The fees ranged from $25 for a single appearance to nearly $23,000 for multiple appearances by individual speakers.
Again, we're not sure why we're so obsessed with how much money physicians make and where that money comes from. Perhaps it's because of the trust we put in them to act in our best medical interests. But shouldn't other key players in healthcare be subject to the same level of attention? How about insurance company presidents? Healthcare system CEOs and hospital administrators? Vendors and suppliers? Directors, officers and trustees of any healthcare group? Sounds like good medicine to us.
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