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Aside from breaking her word to the AMA and physicians across the country, Democrat House Speaker Nancy Pelosi has effectively demolished doctor reimbursements for most of the healthcare industry.  The 21.2% Medicare fee schedule cut has taken effect, but what most do not realize is that the Medicare fee schedule is the gold standard for provider reimbursement fee schedules across the nation.

Essentially, where Medicare goes, insurers follow for the guidelines in covered services and baseline physician fee schedules for private payers as well as worker’s compensation and automobile insurance companies in most states, as well as Medicaid and Medicare itself.

What Pelosi has effectively done is saved the insurance companies who use the Medicare fee schedule millions of dollars of payouts to physicians on their claims–regardless if the patient is a Medicare patient.  I’m not seeing the insurance lobby out there right now, are you?  However, on the provider side, the doctor’s lobby groups are outraged at Pelosi’s failure and the damage this inaction will cause physicians–especially private–and force them to layoff employees to make up for the loss in reimbursements to cover their enormous monthly overhead costs.

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Rationing Medicare will not require clandestine meetings in smoke filled rooms. Simply reduce physician reimbursement to below the cost of delivering quality care, and free market forces will take care of the rest.

Medicare has already begun the process of backdoor rationing. Facing overwhelming budget shortfalls, Medicare needs to trim its books. Washington found a clever solution: eliminate the billing code for “physician consults.”

As a hospital physician, I often admit Medicare patients with chest pain or shortness of breath. If my patient needs urgent help from a cardiologist, I call a colleague for assistance.

Until December 31, 2009 the cardiologist could charge a “physician consult” fee for getting out of bed, coming to the hospital, and evaluating a patient with a potentially life threatening problem. Medicare paid $195.76 for this middle-of-the-night work (the same rate as when done during the day).

By eliminating the “physician consult” billing code, Medicare now advises the specialist to charge for a “hospital admission.” For two more months, Medicare will pay $175.67 for this service. However, without a change in current law, the physician’s reimbursement for a “hospital admission” will drop to $141.63 on March 1. This is why the “Doc Fix” is so important for working physicians and their Medicare patients.

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From Bloomberg:

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.

“We firmly believe that Medicare needs to be reformed,” Yardley said in a Dec. 23 e-mail. “It has been true for many years that Medicare payments no longer reflect the increasing cost of providing services for patients.”

Mayo will assess the financial effect of the decision in Glendale to drop Medicare patients “to see if it could have implications beyond Arizona,” he said.

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The controversy surrounding the recent mammography guidelines issued by the U.S. Preventive Services Task Force is a recommendation for swift and decisive defeat of efforts to expand federal oversight of health care.  It almost seems as if this was designed as a laboratory experiment to learn exactly what will happen under Obamacare.  The results validate some of the most compelling arguments that opponents have made over the past few months.

When opponents claim that Obamacare will lead to rationing of medical services, defenders counter with an irrelevant but true retort that care is already rationed by insurance companies.  By this logic, everything is rationed by economics.  Housing is rationed by the availability of capital to invest in housing which is a collective market choice.  Cars are rationed in that you can’t just walk into a dealer and drive off the lot.  So, yes, currently the health care market, mostly in the form of third-party payers (insurers and public programs), rations care in that there are finite resources to pay for treatments and everyone cannot have everything any time they wish.

The reason that argument is irrelevant is that the debate here is about government rationing of care, which represents an entire new level of restrictions on individuals.  When the government sets up panels of “experts” to make recommendations of what kind of care is appropriate under what circumstances and those recommendations are implemented in the form of regulations over what care will and will not be paid for by both private and public insurance, it limits the rights of patients to control their care in consultation with their physicians.  It also destroys the market for those excluded treatments which then become either prohibitively expensive or entirely unavailable.

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The first game in a long series of Obamacare battles is complete and the liberals lost Game 1 by 13 votes.  The Senate voted against a procedural motion to debate the so-called “Doc Fix” bill Wednesday.  Just as Manny Ramirez of the Los Angeles Dodgers has taken a beating in the media for leaving Game 5 of the National League Championship Series early to take a shower and hitting a mere .250 for the series, Senator Harry Reid has taken a beating in the press for marching the Democrat Caucus into a losing vote in the first battle over Obamacare.

A bipartisan coalition of senators concerned about spending stopped Senators Reid from bringing “Doc Fix” to a vote with 13 Democrats siding with the entire Republican Caucus.  Democrat Senators Evan Bayh of Indiana, Robert Byrd of West Virginia, Kent Conrad and Byron Dorgan of North Dakota, Russ Feingold and Herb Kohl of Wisconsin, Claire McCaskill of Missouri, Bill Nelson of Florida, Jon Tester of Montana, Mark Warner and Jim Webb of Virgina, Ron Wyden of Oregon and Independent Democrat Senator Joe Lieberman of Connecticut all opposed the motion to start debate on the bill.

The strategy to pass the “Doc Fix” outside of Obamacare in an attempt to buy off doctors groups’ support for Obamacare was documented in the media.  The Hill reported earlier this week that “the White House and Democratic leaders are offering doctors a deal:  They’ll freeze cuts in Medicare payments to doctors in exchange for doctors’ support of healthcare reform.”  Clearly the majority of senators would not go along with this strategy because the $247 billion price tag for the bill was too high to buy Obamacare. 

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