Monday, November 29, 2010

“Just fix it!”

Earlier today, the American College of Physicians announced that it had sent to congressional leaders a short video that features internists – speaking in their own words – issuing a heartfelt plea for Congress to avert the scheduled Medicare Sustainable Growth Rate (SGR) cut and work toward putting an end to the repeated cycle of cuts.

The 3 minute and 25 second video, which also is featured on YouTube, emphasizes how patients will be hurt by the scheduled cuts. The videos are the second phase of an ACP initiative to break down the firewall between members of Congress and physician-constituents by combining old-fashioned story-telling with the kinds of short video links popularized by YouTube.

The new video clip may not be as entertaining as the usual YouTube fare, but it tells a compelling story, in the words of the physicians themselves, about the damage being done to patients by the SGR. Excerpts:

From New Haven, Connecticut:

“I urge you to figure out how to make this SGR problem go away. It is very difficult to imagine that physicians are going to be willing to jump on the health reform bandwagon when at the other end of the equation Medicare is threatening these cuts.”

From Charlottesville, Virginia:

“For 35 years I ran an internal medicine intern program … I spent many hours giving career choices to med students. Over past 10 years they’ve become quite aware of the SGR and the uncertainties it provides in reimbursement for primary care physicians.”

From Delray Beach, Florida:

“My overhead goes up, my hard working, diligent employees need and deserve raises. My overhead increases, my supplies increase, I need to be able to afford to stay in business so that I can be there for my patients.”

From Cleveland, Ohio:

“In my family I’ve had a family member who lost his physician and spent the last four years of his life without a primary care physician because none of the primary care doctors in his community where taking on new Medicare patients. So I’ve seen the effect both in my patients and my family.”

From Middleton, Delaware:

“We cannot sustain our [solo] medical practices when receiving such a cut.”

From Thomson, Georgia:

“Where are my patients going to go if my doors close?”

From Lexington, Kentucky:

“It needs to be fixed … yesterday …”

From Sacramento, California:

“… not only for the people over 65… but also for the members of our military services and their families and the retirees and their families.”

From Seattle, Washington:

“I am urging you to repeal the SGR … to do this sooner will cost less … not only in dollar amounts but also in patients’ lives and our physician practices.”

From Tucson, Arizona:

“Just fix it.”

A few hours after ACP released the video, the House joined the Senate in passing legislation to keep current Medicare rates in effect through the end of this year. President Obama is expected to sign it within hours, thereby averting a 23% cut scheduled for December 1. Now, to be sure, I am not attributing enactment of this short-term fix to ACP’s video clip. The video is just one part of the effort being made by ACP, the AMA, AARP, and many, many others to get Congress to stop the cut.

The lame-duck Congress still must take action to prevent another SGR cut schedule for January 1, 2011. Then, the new 112th Congress must work on a bipartisan basis with the White House to enact a longer-term solution that leads to permanent end to the cycle of Medicare physician payment cuts.

That is, Congress still needs to heed physicians’ pleas to “just fix it” - not just for another four weeks, or for another year, but permanently.

Today’s questions: What do you think of the ACP video? How would you make the case to Congress to “just fix it” - once and for all?


rcentor said...

Well done!

I wish I could muster optimism for December.

Steve Lucas said...

I am disappointed in that this is not a new or unknown problem. My understanding is that these cuts were used as part of the financial calculation to balance the most recent health care bill.

What I see, as a business person is an attempt to change the health service delivery model that essentially excludes front line physicians. My opinion is that the push is for other professionals to deliver this care, and doctors become consultants, or move into a management role.

The loss will be to those truly ill patients needing the skills of a physician to treat multiple problems, and to physicians, who will loss what, if any, job satisfaction that is left in providing front line care.

Steve Lucas

Harrison said...

I saw a discussion of the SGR between the newly elected Senator from Kentucky, who happens to be an ophthalmologist, and the new CNN late night talk show host and former New York Governor.
Mr. Spitzer pushed Dr. Paul to explain why the public should support a repeal of the SGR. Dr. Paul just barely started to make a case when Mr. Spitzer asked him to tell how much money he had made off of Medicare in his practice over the years.
Dr. Paul retorted back something along the lines of: I don't think we want to discuss personal past histories.

And that to me symbolized the sad state of our current political situation.

We have a newly elected Senator who does not have the rhetorical skills to defend the position of his own chosen profession, and to make the argument into one focusing on patient care.
And instead we see an immediate degeneration of the discussion to a level of threatened personal attacks.

The argument is not really about the merits of the SGR repeal.
It is about the dysfunctional level of public discourse.
It is about political advantage.

I expect that the discussion will founder and eventually we will have the enactment of these cuts.
And then the political argument will focus on blame.


PCP said...

Now we see the Cheerleaders of PPACA talking about their doubts that it will be fair to us physicians. Really guys, it took you this long? I am sure there are still a few believers. You likely will need a bit more time. Blame game? Why with the professional leadership whole heartedly endorsing it, what issue could a private practice physician have with their position?

Steve Lucas is absolutely correct, this is about the disembowelment of a venerable profession. Technology has come a far way and given us many tools. This has allowed care to become more and more complex requiring team building and organization. However somewhere along the line it was forgotten that there still needs to be someone accountable, and looking at the big picture. Someone whose role is so valuable, that, he/she might have to sometimes take charge and advocate for the patient in a forceful and powerful and self assured way.
Instead we have the ACP endorsing a policy which endorses Medical homes, and even ANP......soon to be DNP led medical homes.
This is the end for general IM. Mark my word. Our roles will evolve, I realise that, some of us are already moving into other things as resourceful people do. However for those of us who feel that something will be lost in frontline patient care, it is a massively regressive step. Worse yet, I am certain it will not save money, and instead do the exact opposite, for it is the pen of the care provider rather than their reimbursement that incurs the most cost. It matter not whose hands that pen is in, and I dare say that such a pen in less self assured hands wastes more.

The worst part is that we would have got to that point with the acknowledgement and dare I say whole hearted support of our professional organizations. It would atleast be some consolation if that eventual outcome were to occur with some advocacy against it.

I have said it a long time ago. Lets see how the AMA and ACP deal with the Tea party on the SGR issue post Obamacare passage. With private practices teetering on the brink, this is literally D Day for private practice medicine in the USA. Some of you might have seen the result of the survey of private practice doctors done by the Physician Foundation recently. If not you might want to take notice.

Anonymous said...

The SGR is only one of several forces that has diminished profitability in the practice of medicine.

If future videos are planned, the case for any "fix" to this or any of the policy issues that affect the practice of medicine, has to be made while including affected patients.

This has been lacking severely. Patients are not overwhelmingly on the side of the physicians, still seeing them as privileged and spoilt.

As the issue is thrust further into the public domain (and youtube may be the most public of domains in today`s world) it will be important to SHOW that this affects patients and the public in general. Just saying so will not do the trick.

A more effective video will move from verbal anecdotes about affected patients and include patients giving their own testimony on the issue at hand.

If we are about patients than we have got to be ALL ABOUT patients.