government

Medicare pay formula needs repair, Sebelius says

Rep. Michael Burgess, MD, and Surgeon General Regina Benjamin, MD, also spoke at the AMA's National Advocacy Conference. Topics included health reform, obesity and violence prevention.

By Doug Trapp — Posted March 15, 2010

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Health and Human Services Secretary Kathleen Sebelius told a physician audience on March 2 that the Obama administration strongly supports preventing doctor pay cuts by overhauling Medicare's sustainable growth rate formula.

"We need a permanent fix for the SGR," Sebelius said at the American Medical Association's annual National Advocacy Conference. But the administration cannot pass laws alone, she noted. "Congress has to take the next step."

Later that day, the Senate cleared a measure delaying a 21% Medicare doctor pay cut, but only until April 1. Meanwhile, President Obama followed up his Feb. 25 health reform summit by issuing a plan for enacting a revised version of congressional reform bills, while House Democrats searched for votes to adopt the Senate version.

Sebelius addressed a range of issues of interest to physicians during her hour-long keynote speech at the conference, including medical liability reform, care coordination and health IT adoption. She mostly sidestepped potentially divisive topics, such as a provision in the Senate reform bill that would create an independent Medicare advisory board that could impose additional rate cuts on doctors.

But Sebelius drew more applause from the audience when she said Medicare should pay for the four or five preventive care steps that might prevent amputations instead of only paying for hospital admissions and amputations. One in five Medicare patients discharged from a hospital returns within 30 days, she noted, and many have little or no follow-up care.

"We desperately need to make payment adjustments in the health system," Sebelius said. Low pay is one of the reasons medical school graduates are not choosing primary care, she said.

Sebelius, a former Kansas governor and insurance commissioner, also highlighted the administration's commitment to liability reform. "I know the costs of not only liability premiums but defensive medicine are enormous," she said. On March 2, Obama said he supports an additional $50 million for state medical liability reform pilot projects; the administration already has committed $23 million.

Still, Sebelius cautioned that the success of liability reform should be judged on how it affects patients and health costs, not just on how well doctors are protected. "There are low-cost states that have implemented almost nothing on the tort reform scale."

Sebelius, like Obama, continued the push for health system reform. She said thousands of Americans are losing insurance coverage each day. Adopting reform that expands coverage should not be as partisan as it has been, she said. "We have to break this logjam in Congress."

The Republican view

But Rep. Michael Burgess, MD (R, Texas), said public support for the House and Senate health reform bills would not increase even if every Republican in Congress endorsed the legislation.

"The concept of a larger bill really has lost traction with the American people," said Dr. Burgess, who spoke at the National Advocacy Conference on March 3. "We don't have the intelligence, the money, the leadership" to adopt a large reform bill.

Dr. Burgess said House Democratic leaders weren't interested in working with Republicans a year ago even after he reached out to them. Nor did Democrats seek bipartisanship after protests at some health reform town hall meetings in August 2009. Dr. Burgess estimated that for every constituent who called his office to support the House bill last August, 500 called to oppose it.

Democrats did not reconsider their pathway to reform until the special election victory of Sen. Scott Brown (D, Mass.) on Jan. 19. House and Senate Democratic leaders planned to adopt a single health reform bill before Obama's Jan. 27 State of the Union address, but Brown's victory cost Democrats their 60-vote filibuster-proof majority.

"The Democrats walked around for several days literally disoriented," Dr. Burgess said.

Dr. Burgess also questioned why the Obama administration doesn't support a nationwide medical liability reform program with the noneconomic damage caps that Texas has. It works and has attracted thousands of physicians to Texas, he said.

He also spoke about his vote for the Medicare Physician Payment Reform Act of 2009, an AMA-supported bill that the House adopted 243-183 on Nov. 19, 2009. The measure would replace the SGR with a new pay formula based more on physician costs, but the Senate has not passed it. Dr. Burgess was the only Republican to vote for the bill.

"It was tough voting against my party, but I was voting with you guys, so that made it easy," he said.

Keeping patients at the center

Another speaker, Surgeon General Regina Benjamin, MD, said repealing the SGR and enacting medical liability reform are important, but patients -- and their dignity -- always should be at the center of doctors' thoughts.

Dr. Benjamin, who spoke at the NAC on March 2, said she had a tough time leaving her clinic in Bayou La Batre, Ala., to become the nation's top doctor. But she said she now has a practice with 300 million patients.

She said she understands why health plans require co-pays for prescription drugs and office visits, but some of her patients in Alabama don't have the money. One of her patients, a school janitor, needed medication for lower back pain but didn't fill the prescription. Dr. Benjamin had covered prescription co-pays for patients with her own money, but she switched to having a collection jar in her practice so her poor patients were more comfortable accepting help.

Dr. Benjamin said she's interested in obesity prevention and the effect of violence on people's health. She also wants to start a national conversation about proactive ways to be fit instead of focusing so much on weight loss and gain. "We can be healthy and be fit at any size and weight," she said.

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