"Take a provision in the Baucus bill that would punish any physician whose 'resource use' is considered too high. Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program—and then automatically cut all payments by 5% to anyone who falls into the 90th percentile or above. In practice, this rule will only apply to specialists."
What is "resource use?" The WSJ explains that each year Congress allots "x" number of Medicare dollars to doctors. Period. Divide it up between all services. How much one area of billable service gets is called a Relative Value Unit, for example, "in 2008, a colonoscopy earned 5.64 of these units, a hip replacement 37.66. Then it multiplies a doctor's total RVUs by some dollar factor, currently about $36, and cuts a check."
But, under the Baucus bill, "The basic tools of heart specialists—echocardiograms (stress tests) and catheterizations—are slashed by 42% and 24%, respectively." That equals rationing. If this patient needs that test maybe more than you might, you have to wait, because I'm not going over my RVU and getting fined!
Oncologists? Forget it:
"Cancer doctors get hit because the Administration believes specialists order too many MRIs and CT scans. Certain kinds of diagnostic imaging lose 24% under new assumptions that machines are in use 90% of the time, up from 50%. There isn't a radiologist in America running an MRI 10.8 hours out of 12, unless he's lining up patients on a conveyor belt. But claiming scanners are used far more often than they really are lets the Administration "score" spending cuts."
Brian Faughnan, writing for Red State, last week points out that these penalties would apply each year. Every single year the top ten percent of offenders would get penalized.
Faughnan also worries about how these cuts will affect treatment for seniors. Wouldn't they be the first to be denied tests?
The National Right to Life Committee has the same concerns: “This provision does not link funding to outcomes or quality; instead, it will force a ‘race to the bottom’ with relentless pressure on doctors to limit health care for their older patients,” the group said. “On top of the significant Medicare cuts in the bill, this will gravely endanger the lives of America’s senior citizens.”
Faughnan lists those who voted to keep this provision in the Baucus bill:
The Senators who voted to keep this provision are:
Max Baucus, MT
Jay Rockefeller IV, WV
Kent Conrad, ND
Jeff Bingaman, NM
John Kerry, MA
Blanche Lincoln, AR
Ron Wyden, OR
Charles Schumer, NY
Debbie Stabenow, MI
Maria Cantwell, WA
Bill Nelson, FL
Robert Menendez, NJTom Carper, DE
So basically, as the Washington Times pointed out on September 25, if a doctor orders an expensive, life-saving treatment, he is likely to be fined for it, no matter how successful it was or how important it was to saving a life. The incentive is to keep costs down, order fewer tests, and stay out of that top ten percent.
As it stands now, the Baucus bill has been put on hold awaiting scoring by the CBO. Hot Air reports that "Democrats had tried to push the bill out of committee before the Congressional Budget Office could review the proposal and project its costs, fearing that another harsh analysis could kill the Senate effort before it has a chance for a floor vote. " It isn't likely to score well.
Obama can suit up all the actors in white coats that he wants to, it won't change the fact that Obamacare is all about controlling costs and not at all about health care. And that means rationing.
(More at Memeorandum)