Friday, October 16, 2009

The Stabenow bill to abolish SGR,accounting trick and/or small payoff to the doctors?

Senator Debbie Stabenow has introduced a bill to abolish the dreaded SGR ( Sustainable growth rate) mechanism by which physician fees under Medicare were theoretically reduced every year to compensate for an overall increase in Medicare expenditures. "Theoretically" because typically at the last minute Congress responded to the annual humiliating begging of doctors to not really have the cut so none occurred. A 21% cut is due in January 2010. The bill will do away with the annual debacle of the only profession in the United States living under price controls coming to Washintton whinning and holding their breath until congress relented and did not enforce the reduction.

The Baucus bill ( or the vapor bill as skeptics call it) did not abolish the SGR and part of its alleged savings was to be the annual taking it out on the hides of doctors via SGR. This bill will also abolish those putative savings.Hence the reference in the title to the accounting trick. So one could vote for Baucus's savings with a wink knowing the savings would be vapor with the passage of Stabenow.

Of course, I favor doing away with the SGR;it was a terrible idea which was bound to self destruct or at least destroy medical practice as we once knew it.However, the basic price controls on physician's Medicare payments remains in place and periodically congress will threaten further cuts and off to Washington will the representatives of AMA,ACP,ACCP etc to to plead for more money.

Price controls almost always lead to 1)increased demand for the good or service,2) decreased supply of the good or service 3) poorer quality and 4) black markets. Since CMS put into place the price controls on physician's Medicare fees the first three have come to past and only number 4 is yet to be realized.The Stabenow bill, if passed,will help a little bit, but the problem remains.

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