To Honorable Phil Gingrey, Hon. Phil Roe, and other members of the Doctors’ Caucus
From: Association of American Physicians and Surgeons
This is with reference to your February 7 press release, which cites your December 13 letter concerning necessary provisions in any legislation addressing the SGR formula.
Attached is our press release on this subject. This letter concerns the points you raise, which unfortunately omit the main issue: government price controls.
- “Ensure a positive update for providers.” If physicians cannot increase fees enough to keep up with the cost of expensive government mandates and the deterioration of the dollar, they will no longer be able to stay in business. A 0.5% yearly increase, or any fixed percentage, will likely be insufficient.
- “Ensure a sufficient transition.” We oppose the top-down imposition of any government payment model, with or without a transition period.
- “Maintain a viable fee-for-service model.” Payment for work done is not a model, but the standard method of payment in a free market. What “alternative” has demonstrably worked by any means other than incentivizing denial of care?
- “Reject direct physician competition.” We agree that physicians should not be competing against each other in a zero-sum game. We reject any “pay-for-performance” provisions that basically pay for bureaucratic compliance. Proposed “quality of care metrics” have no proven relationship to value as judged by patients.
- “Maintain a level playing field.” The playing field set by Medicare reimbursements is already very far from being level. Payments to hospitals by Medicare and Medicaid are much higher than payments to physicians for exactly the same procedures—often nearly twice as high. It means that hospital cartels are thriving and expanding, while independent physicians are being starved and driven out of independent practice, often into employment relationships with hospitals, decreasing access and competition. On a truly level playing field, players can perform to the best of their ability and reap commensurate rewards. Medicare reimbursement prevents physicians from recouping the costs of their much longer education and higher expenses by mandating that they can receive at most 15% more than minimally trained “midlevel providers.”
- “Establish physician-led quality metrics.” The process for establishing such metrics inevitably involves expensive bureaucracies and likely conflicts of interest. Physician-led specialty organizations have established a highly lucrative cottage industry for “Maintenance of Certification/Maintenance of Licensure” in the name of “quality,” with no proven value to patients.
- “Prevent expansion of medical lawsuits.” Government-approved metrics will inevitably lead to more lawsuits; any deviation could be a cause of action.
- “Keep it simple.” All proposed models for “quality reporting systems” or “new payment models” impose extremely complex, expensive, and counterproductive administrative burdens. They also violate the promise that enabled the passage of Medicare: that government would not interfere in the practice of medicine.
It is abundantly clear that Medicare is unsustainable. The proposed “fix” to the SGR does nothing to make it sustainable, but it will cause further deterioration in quality and access to care. Congress should focus its attention on minimizing damage to the medical system, instead of protecting the flawed structure of the Medicare program.
In our lawsuit against the Patient Protection and Affordable Care Act (AAPS v. Sebelius), which we filed three days after PPACA was signed into law, we have pleaded for relief from the court in the form of requiring an independent accounting of the fiscal state of Medicare and Social Security. Why is Congress not demanding this even without a court order?
I would be happy to answer any questions.
Sincerely yours,
Jane M. Orient, M.D.
Executive Director
