Monday, March 1, 2010

Medicare And Anesthesiologists

There is a lot of handwringing in the medical blogosphere today about the 21% cut in Medicare reimbursements. Some are advocating dropping Medicare patients completely as a sign of rebellion. With Medicare payments so low, many doctors feel they can do better by not accepting Medicare. After all, what's the point of keeping these patients when the payments are below the cost of rendering services. It's like the clueless retailer who sells goods below cost but tries to make it up in volume. The numbers just don't add up. Some people say that because doctors are obligated by the Hippocratic Oath to treat the sick that we should just suck it up because it is the ethical thing to do. What I never understood is why it is the physicians' responsibility to go into bankruptcy to take care of patients when the public and the government refuses to pay for such services? If people feel that strongly about taking care of the elderly and the disabled then maybe they should do some sacrificing of their own, such as paying higher taxes, to treat them.

Anesthesiologists are in a different boat. True we will still get 21% less for treating Medicare patients. But unlike primary care doctors we don't have the option of dropping these patients from our practice. When anesthesiologists sign up to provide services for a hospital, one of the requirements usually is acceptance of Medicare. Otherwise the surgical services would be completely chaotic. If a surgeon brings an elderly patient in for a hip replacement, it would be detrimental for all involved if the anesthesiologist cancels the case because he doesn't accept Medicare. So you see anesthesiologists pretty much have to grin and bare it when it comes to accepting below cost Medicare payments.

The Senate is set to introduce legislation that will put a temporary patch on these Medicare cuts. This will give them time to find a more permanent fix but I'm not holding my breath on that one. They'll just put in another one year fix because they can't come up with the money for a real repair of Medicare's SGR formula. In the meantime Congress is still debating passage of healthcare reform that will permanently decrease the pay of physicians regardless of what Medicare does.

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