I became angry the other day. We’ve all been watching the ongoing debate about healthcare reform. The Democrats recently celebrated the U.S. House’s passage of a healthcare bill.
News in the U.S. Senate wasn’t so great. Senators said that the bill was dead if the government's public option wasn’t modified. Obviously, compromise will need to be part of any final bill’s passage.
Perhaps you’re wondering why I was angry? Was it the fact that major changes are in the works for healthcare? No. My anger wasn’t about passage of a bill for healthcare reform. I think everyone would agree that our healthcare system is in need of some significant improvements.
What angers me is how unilateral decisions about how healthcare are delivered with little inclusion of physician input.
What am I talking about? Well, Medicare recently decided that a significant drop in physician payments is in order. In January, many cuts are planned for physician payments from Medicare. Specifically, they plan on reducing the payment for the nuclear stress tests that are done in physician offices by 36%. This is after a cut of 20% was passed on these tests in 2009.
So, in 2 years time, Medicare plans on cutting payments to physicians on an essential test for diagnosing heart disease in Medicare patients by 56%. What’s the rationale for such a reduction? Medicare doesn’t say-except that too much money is being spent on health care.
What will be the effect of such a drastic reduction in payments to physicians for this test?
Imagine if your boss decided to unilaterally to cut a big chunk of your salary by 56% (In some cardiology practices nuclear testing accounts for 25% of income. A cut by 56% means a salary reduction of 14%. This is on top of a reduction in other services of 15%. In January of 2008 some other tests were cut 25%)
Clearly some cardiologists and internists will no longer be able to offer this test to their patients. Access to care will be limited.
Of course congress says, “Care to Medicare patients will not be limited.”
Medicare has also decided that heart catheterizations are too expensive. A heart catheterization is a test done in the hospital where a cardiologist examines the heart arteries for heart disease. He/She places a needle into the large artery of the leg. Plastic tubes are passed up into the heart and dye is injected to diagnose heart blockages. The test takes anywhere from 30 minutes to an hour to do (the actual test). Further time is spent reviewing the images, talking to the patient, their family, and dictating a report that goes in the medical record. The risks of such a procedure include minor or major bleeding, a heart attack, risk of tearing the heart arteries, strokes, or death. A heart catheterization in my book is a fairly big deal. In the 20 years that I have been in practice I have seen people have a stroke following the procedure. Patients have had significant bleeding, and I’ve even seen people die.
