Docs Unhappy With Medicare, But Can't Agree on a Fix
MedPage Today October 26, 2010
Most physicians believe current Medicare payments are unfair, but there is little consensus among doctors on how to make payments more equitable, according to a new study.
While physicians generally support changing how Medicare reimburses doctors, most don't support payment reforms that would reduce their own incomes, according to survey results published in the Oct. 25 issue of Archives of Internal Medicine.
Physician spending accounts for about one-fifth of all healthcare spending, but the clinical decisions of doctors are a "major factor" in rising healthcare costs, and many have looked to physician reimbursements as "potential targets to promote cost savings and establish incentives to improve care," wrote the study authors, who were led by Alex Federman, MD, MPH, of Mount Sinai School of Medicine.
In order to assess physicians' opinions on reimbursement reform proposals, researchers conducted a national mail survey of 6,000 randomly selected doctors from the American Medical Association Masterfile between June 25 and Oct. 31, 2009, which was several months before the Affordable Care Act (ACA) was signed into law. In all, 1,222 physicians responded, most of whom reported accepting Medicare.
Physicians were asked about their support for several new payment options, including: rewarding quality with financial incentives; bundling payments; shifting payments from procedures to managment and counseling services; increasing pay to generalists; and offsetting the pay increase for generalists with a reduction in pay to specialists.
The survey found that 78% of doctors surveyed felt that some procedures are compensated too highly and others are not compensated enough to cover costs.
Offering incentives was the most frequently supported payment reform option, with nearly half of surveyed doctors saying they support a model in which doctors would be paid bonuses for meeting certain quality standards, such as preventing rehospitalization. Doctors would be penalized for providing "suboptimal" care as well.
Overall, 46% of physicians opposed shifting payments away from procedures and toward counseling services, while 42% of physicians supported the option. Not surprisingly, doctors who make their living performing procedures, such as surgeons, were much less likely to support moving payments away from procedures, while most generalists (67%) supported the proposal.
Bundling payments -- defined as paying for a specific episode of care with one fixed amount -- was supported by just 17% of doctors.
"Physicians generally showed the least support for proposals that carried the risk of reduced reimbursement, such as payments for bundled care," the authors wrote.
Bundled payments are cited frequently by health policy experts as a viable payment reform option, and the ACA also promotes bundled payments.
"Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation," the authors wrote.
Nearly 80% of physicians surveyed supported increasing pay for generalists. Even among surgeons, more than three-quarters supported boosting pay for generalists.
However, offsetting the higher payments by decreasing payments to specialists was supported by just 39% of doctors.
The ACA did include a payment bonus for primary care physicians, but no reduction in payment for services provided by specialists.
The study authors conclude that doctors are not satisfied with current Medicare reimbursement, but don't agree on how best to reform the payment system.
"The successful adoption of payment reform proposals may require a better understanding of physicians' concerns and their willingness to make trade-offs," the authors conclude. "In addition, maximizing physicians' approval of reforms would facilitate implementation."
The researchers said their study is limited by a slightly-lower-than-average response rate, and also limited because the opinions were collected as proposals for healthcare reform were in flux in Congress.
This study was supported by a grant from the Robert Wood Johnson Foundation and also by grants from the National Institute on Aging; the National Heart, Lung, and Blood Institute; and the Veterans Administration Health Services Research and Development Service.
The authors reported no financial conflicts of interest.
Primary source: Archives of Internal Medicine
Source reference:
Federman A, et al "Physicians' opinions about reforming reimbursement" Arch Intern Med 2010; 170(19): 1735-1742.
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Mark Murphy: 'Yes' to life-saving Amendment 2Savannah Morning news By mark e. murphy
Created 2010-10-26 00:18
I will remember Feb. 7, 2008 for the rest of my life.
I was eating dinner with my wife in Spanky's that evening when my cell phone rang. It was my partner, Dr. Steve Carpenter, the head of Memorial's Internal Medicine residency program.
"Murph, the sugar refinery blew up," Steve said. "We're calling everyone in."
A wave of nausea washed over me. I flicked my eyes up at my wife, who was finishing off a chicken finger. Her brother Larry had worked at that plant.
"Larry's not at the sugar refinery, is he?" I asked.
He was not; he'd been ill, and had in fact changed to a different plant a few years earlier. Our family had been spared that night. Others were not so fortunate.
In the end, 14 people died as a result of the Imperial Sugar disaster. Another 42 were injured. Many more might have died had it not been for the rapid, coordinated response of Savannah's medical community - and, particularly, of the physicians, nurses and support personnel at Memorial Health University Medical Center, the area's only Level One Trauma Center.
Not all emergency rooms are trauma centers. Trauma centers are designated facilities which are required to meet certain standards to achieve that designation.
Level One Trauma Centers, like Memorial's, must have multiple medical specialties available 24/7 so that they can be responsive to any disaster which might arise. Georgia currently has only four Level One Trauma Centers. Besides Memorial's, the others are in Atlanta (Grady), Macon (Medical Center of Central Georgia) and Augusta (MCG Hospital). There are 12 other lower-level trauma centers in the state, which is not enough.
It's estimated that Georgia should have at least 30 trauma centers to be adequately staffed. In many cases, if a victim of major trauma is not at a trauma center within 30-60 minutes of an injury, that person will die when they might have otherwise been saved. Approximately 700 people die unnecessarily each year in our state as a result of trauma because our state is medically underserved in this area..
This is a tragedy. But it is a correctable tragedy.
The state has an opportunity to shore up its statewide trauma network in the upcoming election. It is a vote that has more potential impact of the everyday lives of Georgians than any political election this year.
Trauma care is an often thankless job. Many victims of trauma - be they the victims of gunshot wounds, automobile wrecks, drownings - are uninsured. Moreover, medical reimbursement overall is declining and will continue to decline.
Without a dedicated source of trauma funding support, many hospitals which currently maintain trauma centers will not be able to keep those centers open, to the detriment of all Georgians. Memorial Health, for example, lost $6 million dollars providing ER care for uninsured patients in 2007 alone. This is not sustainable without outside assistance.
A "yes" vote on Amendment 2, which is on the Nov. 2 ballot, will afford Georgians the opportunity to maintain the state's trauma network by using a $10 car tag fee to provide dedicated trauma network support. It provides funding that cannot be diverted by legislators for less noble purposes.
For less than the price of a few gallons of gasoline per year, Georgians can build a trauma network that can be broadened in scope and strengthened in depth.
Our area has seen its share of disasters. In addition to the Imperial Sugar explosion, one might recall the 1959 Meldrim train derailment (23 dead), the 1972 Sidney Lanier Bridge collapse (11 dead), the 1949 crash of a B-50 bomber (11 dead), the 1948 crash of a chartered airplane (17 dead; nine injured), the 1953 B-29 crash (11 dead), and the 1929 boiler explosion in a Glennville factory which killed five and injured five more.
This does not take into account the numerous Savannah disasters of the latter part of the 19th century, including two large downtown fires and the devastating hurricanes of 1893 and 1898. A healthy trauma network can be the difference between life and death in these situations - in addition to the less dramatic, but no less significant, impact that such a network can have on people involved in more routine automobile accidents and gunshot injuries.
A healthy trauma network benefits all of us. It does not discriminate and is not political. Voting to support it is, quite simply, the right thing to do - for all Georgians.
Mark E. Murphy, M.D., is a Savannah physician and writer.
Supporters of Ga. trauma-care amendment rallyMorris News Service Tuesday, Oct. 26, 2010 4:17 PM
ATLANTA -- Rarely do political gatherings on the Capitol steps stir partisans to tears, but Charlotte Laverty’s story Tuesday of her son’s fatal car wreck did during a rally in support of a constitutional amendment for trauma care.
She told of how her dinner out with her husband was interrupted with news of the accident, of rushing to the scene less than a mile from home, and of arriving at the hospital moments after an ambulance delivered her 17-year-old.
“We were fortunate that we live in a town that has a trauma center,” she said, listing the many specialists who were on call the night of the wreck who tended to her son.
Although he died two days later, she was thankful for the chance his out-of-town family had to say their good-byes.
“If I lived in a rural area and thought, ‘had I only paid 10 extra bucks for my car tag I might have gotten the care that Grant Laverty got.’ How can you forgive yourself?” she asked.
Some of 100 or so nurses, doctors, rescue personnel and business executives attending the rally choked up as she spoke. Her comments were punctuated by the siren of an ambulance on an emergency call a few streets over.
The goal of the rally, and one in Savannah at the same time, was to build support for Amendment 2 on this fall’s ballot. Approval would add a $10 yearly fee to most vehicle tag renewals with the expected $80 million going toward a statewide network of trauma-care centers.
The state’s 189 hospitals only house 17 specialized trauma centers. Experts say the state needs 30 of them, and the specialists on call around the clock to treat the most challenging accident victims.
“When you leave the Bibb County line heading south on Interstate 75, there is not a single neurosurgeon on call until you get to Gainesville, Fla.,” said George Israel, president of the Georgia Chamber of Commerce, one of the backers of the campaign, Yes 2 Save Lives.
The campaign’s internal polls show it has the support of slightly less than what’s needed for passage. The sticking point for opponents: distrust of politicians to use the money as promised.
Israel stressed that by using a constitutional amendment to create the fund, supporters have prevented any other uses.
“Rest assured the $10 is locked in. The politicians are locked out,” he said.
Chad Black, a Hall County paramedic and the face of Yes 2 Save Lives’ campaign commercials, said he’s been pushing for a trauma-care network for a decade because the state has 20 percent less emergency coverage than the national average. That shortage results in about 700 lives lost each year.
“It’s been very difficult watching people die who shouldn’t die,” he said.
Rally For Amendment 2 To Help Build Georgia's Trauma System
WSAV-TV 10-26-10
Georgia voters next Tuesday will decide if they want to add ten dollars to their tag renewals in order to get better trauma care. A small crowd gathered in Forsyth Park today in support of Amendment 2. The money would help build a better trauma care system throughout the state. A recent study showed Georgia’s growing population needs 30 trauma care centers throughout the state. We currently only have about half that number.
Memorial Health Trauma Surgeon Dr. Gage Oschner says, "We don't have enough trauma centers - this is where we have most of our preventable deaths - are in this area cause people just can't get to us and I see one or two people a month, maybe more - that did shortly after they get to me - had I got 'em 20, 30 minutes earlier - they weren't hard to save - any good surgeon could do it - but they didn't get to us in time.” Proponents say the money raised from the new fee could not be diverted to other things and would be a renewable source of revenue to help fund trauma centers each year.
Physicians and survivors push for YES on Nov. 2
WTOC Savannah 10-26-10
SAVANNAH, GA (WTOC) - When you head to the polls next Tuesday, you'll be voting on more than who takes over in various offices.
Voters in both Georgia and South Carolina will decide the fate of a number of proposed constitutional amendments.
In Georgia, there are five amendment questions on the ballot.
One of the most widely discussed is whether or not to add a $10 fee on private passenger vehicle tags to establish and fund a statewide trauma care system.
The annual $10 trauma charge would be on passenger vehicles designed to carry 10 or fewer passengers. Passenger vehicles include cars, SUVs, pickup trucks, and motorcycles, but does not include large transfer trucks or government-owned vehicles.
The annual charge will be collected at the same time as other license tag and registration fees required by law prior to the issuance of a license plate or revalidation decal and will be deposited in the Georgia Trauma Trust Fund.
It is estimated that the $10 charge will raise $78 million a year in revenue that will be dedicated to trauma.
That $10 goes to training first responders and helping fund trauma care centers where there are none.
Hospitals and survivors are asking you to say yes to Amendment 2.
"We got to trauma at Memorial within 15 minutes. That saved my life," Shae Cowart McDaniel told WTOC.
McDaniel shared her story with WTOC and everyone at an Amendment 2 rally for trauma care at Forsyth Park Tuesday morning.
In 2007, McDaniel was involved in a near-fatal accident 30 minutes from Savannah.
"We hit a tree. It started spinning and we were both thrown from the car," she said.
McDaniel was flown to Memorial Health, broken bones all over her body, paralyzed from the waist down with a punctured lung and liver.
Jolene Cowart believes her daughter would have died if trauma care was not available.
"If we hadn't had lived as close as we did, she wouldn't have made it because time was crucial," Cowart told WTOC.
"Who knows what would have happened," McDaniel said.
"Where we live, around us, we don't have enough trauma centers. This is where we have the most preventable deaths," Dr. Gage Oschner told WTOC.
Dr. Oschner is a trauma surgeon at Memorial Health and says a trauma network, serving all communities, is a necessity.
"I see one or two people a month, maybe more, that die shortly after they get to the hospital. Had I got to them 20 - 30 minutes earlier, they weren't hard to save," Dr. Oschner said.
Oschner told the Forysth Park audience, $10 extra a year when you register your car tag could raise $80 million to develop trauma care in areas where none exists, giving crash victims and others a better chance to survive.
He says the $10 will go directly to hospitals. "Nobody. No politician can mess with it. Every penny goes to trauma care," he said.
McDaniel is urging everyone on November 2nd to say YES to Amendment 2, ten dollars for trauma care statewide. "That's two happy meals a year and that could save who knows how many lives," she said.
For more information, you can visit http://www.yes2savelives.com/. Also, visit our 2010 General Election page for more election information.
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