Physicians face pressures from increased patient loads, looming payment cuts

Investor's Business Daily: Two provisions of the new health overhaul law "may accelerate a trend" of doctors leaving their profession. It points to parts of the legislation that would ask physicians to accept new administrative chores and standards, although some of them might result in better reimbursement rates from insurers and the government. "Under the health care law, insurers that participate in the exchanges must develop 'a payment structure that provides increased reimbursement or other incentives for improving health outcomes' via practices such as quality reporting, effective care management, care coordination, and medication and care compliance initiatives. The health and human services secretary and a panel of experts will determine the payment guidelines. For Medicare, the health care law empowers the HHS secretary to develop a 'payment modifier' that will increase Medicare reimbursements for quality care. The secretary 'shall establish appropriate measures' for quality." Meanwhile, "[r]eimbursement issues were rated 'most unsatisfying' by more than 54% of doctors surveyed in 2008 by the Physicians Foundation. Managed care issues and Medicare/gov't regulations were not far behind" (Hogberg, 3/30).

Bloomberg BusinessWeek: Seventeen doctors interviewed about the new health overhaul had mixed views. "While they applauded the ideal of greater access to medical care, they didn't necessarily approve of how Congress decided to deliver it to people. ... The Patient Protection and Affordable Care Act put in motion the largest expansion of health care coverage since the creation in 1965 of Medicaid, for the poor, and Medicare, for people 65 and older and the disabled. ... The result will be more patients and less money for doctors already feeling shortchanged by Medicaid and Medicare, said Richard Chudacoff," a Las Vegas obstetrician and gynecologist. Medicaid will be the entry way for many of those who come into the health care system. But because of the program's low payment rates, "many doctors ... say they won't be able to take these new patients (Wechsler and Terhune, 3/31).

McKnight's Long Term Care News: Medicare physicians will again confront a 21.2% pay cut "when a provision to delay the reduction expires at midnight Thursday. But the government has ordered that claims submitted on or after April 1 be held for an additional 10 days until Congress can return from recess. ... Legislation under debate in Congress would have further delayed the pay cut until Oct. 1, but lawmakers adjourned for their April recess before the provision could be passed. The physician pay cut is one provision not covered in the recently passed healthcare reform law. An extension of the Medicare therapy caps exceptions process ... was part of the reform legislation. The process will be in effect until the end of the year" (3/31).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.