Getting Started

I’m going to go out on a limb and suggest that making sure doctors get paid enough isn’t on many people’s end of year to-do lists. In fact, after your daily helping of presidential politics, court transcripts, and talks of another government shutdown (and let’s face it, those happen all the time now) you’d be forgiven for responding to this topic with a healthy dose of skepticism. Even the casual health policy wonk (of which I’m sure there are many) could be forgiven for hearing that we’re facing another doc pay crisis and thinking, “I thought we fixed that already! Tell them to step to the back of the line.”

However, the Senate Finance Committee recently advanced legislation to defray some pretty substantial cuts to provider Medicare payments. And yes, this stop gap measure may feel like Groundhog Day to those of us who were around in the years between 2003 and 2015 – the days of the Medicare Sustainable Growth Rate formula (SGR). Repealed in 2015, the SGR was a budgetary device used to ensure that the yearly increase in the expense per Medicare beneficiary did not exceed the growth in GDP. If health care spending got too high in one year, an equal amount of money would be taken from the pool of funds used to pay doctors the following year. It was an elegant, if shortsighted policy that had accumulated a required 21.2% cut to doc pay before it was repealed. The SGR was replaced with a new model that was to be the single spark to ignite doctors’ passions for pursuing the virtuous (if not abjectly opposed) characteristics of efficiency and value in healthcare.

Instead, we find ourselves back watching Congress at the end of the year, hoping they’ll punt another federal IOU down the road. This time it amounts to reducing a 3.4% cut in physician pay to 2.15% and keeping around a small, time-limited inventive payment for doctors to participate in Alternative Payment Models (APMs). (That’s a whole other story!)

And so, I’m starting out my brand new blog with the broad statement that the physician payment system is broken and your doctors and other health care providers are, indeed, not being fairly reimbursed.

“But, Courtney,” you say, “fairly reimbursed is not the same thing as paid enough. Do you really expect me to believe doctors are poor? Are they really not getting paid?”

My answers are: 1) Thanks for noticing! 2) Not really… and 3) Sometimes. Some of them. Yes

Rather than taking my word for it, however, I hope you’ll join me for a series of discussions on these topics. For starters, there is no shortage of information from my former doc lobbyist colleagues that requires a deeper dive. For the purposes of this brief introduction, I’ll recommend the chart below (and linked resources) depicting physician reimbursement relative to inflation. Even the hopelessly cynical among us can look at this and wonder what’s up.

I also hope to dig into what I think is the more important question here: Why should we care? In my opinion, we should care, but not because I am desperate to get in a battle of who has the prettiest line chart. I think we should care because most people have no idea what we are (and are not) paying for in our healthcare system – and that makes all the difference. Along the way, we’ll have to talk about value in healthcare and why we just can’t seem to figure out what that means. Most importantly, however, I hope to introduce concepts around innovation and value, and why healthcare is at a critical decision point, right now.

And I hope you’ll join me…