T
he impending cut undoubtedly would have devastated physi- cian practices, Dr. Buckingham says. “But it’s especially disap- pointing and unfortunate to have another patch because
this time we really had a workable solution.” She describes the annual ritual as a combination of Ground- hog Day and Chinese water torture: “Once again, we’re brought to the cliff with our feet dangling off, wondering if we are going to get pulled back. It’s painful and exhausting, and in the end we are just trying to take care of our patients.” With each cliffhanger, the stakes climb for physicians and senior patients who depend on them. Even the physician pipe- line is under pressure. When it came time for Vinh Q. Nguyen, MD, to find a job
after residency training in Houston, he forewent setting up his own private practice so he could afford to pursue his spe- cialty as a family physician and geriatrician caring for elderly patients. Instead, he’ll start work in July in a hospital setting. “Without a doubt, the difficulty of doing only geriatric care for Medicare patients would be unsustainable for a young phy- sician coming out wanting to do a solo private practice. It’s not sustainable for physicians’ costs to go up every year and for their payment to stay the same,” he said. The former chair of TMA’s Resident and Fellow Section says his young colleagues are taking that into account when choos- ing their specialties, the kinds of jobs they take, and whether they see Medicare patients. “If we want our senior patients to be able to go to a [less costly] outpatient setting to see their doctors, then something has to change.” The constant uncertainty over the years even forced Dr. Buckingham to put off hiring new physicians like Dr. Nguyen. With 60 percent of her patients in Medicare, “I can’t plan for the future because I don’t know what my revenues are going to be. We don’t hire people when staff quits. We run as lean as we can, and we always keep an active plan as to who we would have to lay off and what patients we can take. We are trying our best to take care of our patients, but at some point, that’s going to be impossible.” That’s why TMA and AMA leaders are eager for Congress to get back to the negotiating table and capitalize on the legisla- tive strides already made. “This is very disappointing, and the worst thing about it is the unpredictability for physicians and patients. If we’re talk- ing about this again in March of next year, that’s a big prob- lem,” warned TMA President Austin King, MD.
AMA President Ardis D. Hoven, MD, echoed that disap- pointment. “We had robust momentum to make something happen, and at the end of the day it was politics as usual. But we are in a much better place than a year ago. We made great progress, and we have good policy. We can’t allow it to lay dead for another year. We need to keep pushing the boulder if we want the speed to pick up,” she said. Lawmakers say they share those sentiments but acknowl- edge the fiscal barriers that lie ahead. “We are closer than ever before; there’s no reason in the world to stop working now, and I don’t intend to do that,” said U.S. Rep. Michael C. Burgess, MD (R-Texas). He is vice chair of the House Energy and Commerce Subcommittee on Health and one of the bill drafters and primary sponsors. “The good news is, we have a policy to repeal the SGR that is agreed to by Republicans and Democrats in the House and Senate. And that’s a big deal. We didn’t have that a year ago. Everybody always knew the hard part was going to be the offsets, and sure enough that was. But just like the Butch Cassidy and the Sundance Kid analogy, we all have to hold hands and jump at the same time.”
Show me the money Until the final hours, lawmakers trumpeted their support for the SGR Repeal and Medicare Provider Payment Moderniza- tion Act of 2014. The legislation was the culmination of more than a year’s worth of policymaking by the House Energy and Commerce, House Ways and Means, and Senate Finance com- mittees. It also drew widespread support from the congres- sional Doctors Caucus and the house of medicine, including TMA and AMA. In addition to repealing the SGR, the legislation would
have provided automatic positive payment updates of 0.5 per- cent for five years; consolidated the current Medicare quality- reporting programs into one streamlined program that links physician pay to a set of physician-endorsed quality measures; and allowed physicians to transition from fee-for-service to alternative payment models. Until now, “we never had a bill on the policy side,” said
TMA Vice President for Advocacy Darren Whitehurst. Members of Congress “showed a willingness to work across the aisle to come up with a policy proposal that was not perfect but was a step in the right direction. “Unfortunately, they didn’t do on the finance side what they did on the policy side in terms of a bipartisan effort,” he said, adding that dealing with a “pay-for” during an election year also likely contributed to their inaction.
June 2014 TEXAS MEDICINE 23
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