Yesterday, I blogged about the controversy over where to find the money needed to increase payment to primary care physicians. The American Medical Association (AMA) addresses this question in a commentary by AMA Board chairman Joseph M. Heyman, MD. He says,
"This issue [increasing the number of primary care doctors], on which we all agree, threatens to break professional unity, cause rancor, divide us and result in everybody - including our patients - losing. We all want to do something to improve the state of primary care. So we need to be certain we are all on the same page when it comes to investing in primary care in this country. We must present a unified front." He then makes three points:
"The American Medical Association absolutely supports this important investment in primary care. Payments to primary care physicians must increase.
The American Medical Association absolutely opposes applying budget-neutrality rules that confine offsets to the physician payment pool. Congress should not rob Dr. Peter, the surgeon, to pay Dr. Paul, the primary care physician.
The American Medical Association absolutely is committed to working with Congress and the administration to find alternate pathways to offset the required increases in primary care payments."
ACP has urged Congress to consider ways to fund primary care outside of the usual budget neutrality physician payment rules. We have argued that primary care pays for itself by reducing preventive hospital admissions, duplicate testing, and so forth. We hope that argument is being accepted by policymakers. And to be frank, ACP will have its own membership issues if increased payment for general internists comes at the expense of reducing payment to IM subspecialists.
It should be acknowledged, though, that budget neutrality adjustments are made every year in Medicare payments to doctors, whenever new procedure codes and relative values are added to the fee schedule. Those adjustments benefit one group of physicians - the ones who do the procedures - at the expense of other physicians who do not. For the most part, primary care physicians are not the ones who benefit (except every five years or so when changes in the relative values for visit codes are put on the table).
Rather than drawing lines against any particular funding option, the conversation needs to shift to how primary care will be funded, recognizing that someone (maybe even some doctors) will have to give up something if primary care is to survive.
Today's question: What do you think of Dr. Heyman's commentary?