Under the proposal, Medicare would put specialists' payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January.
That, combined with other changes, would boost payments to internists, family physicians, general practitioners and geriatric specialists by 6% to 8% next year, said the Centers for Medicare and Medicaid Services, the agency that manages Medicare, the federal insurance program for the elderly and disabled.
Payments to cardiologists would be trimmed by 11% overall, but certain procedures they perform would see steeper reductions. Alfred Bove, president of the American College of Cardiology, figured that cardiologists would receive 42% less for an echocardiogram and 24% less for a cardiac catheterization.
Radiologists would see an estimated cut of 20% for imaging services using expensive equipment such as MRI and CT scans, said Bibb Allen, chairman of the commission on economics at the American College of Radiology. That would be in addition to the cuts imposed on radiologists under a 2005 law, he said.
Well it's not a horrible idea. Primary care physicians are certainly undercompensated compared to their subspecialist brethren. They ought to get paid more. Make it financially viable for them to actually spend more than 5 minutes with a complicated elderly patient.
But let's honest about something; these cardiologists and gastroenterologists and rheumatologists are not materializing out of thin air. The radiologists aren't all sneaking into the hospital at night and ordering ridiculous MRI's on all the inpatients. Cardiologists aren't putting ads on Craigslist for cardiac catheterizations. Someone has to order the MRI. Someone is shotgun consulting all the specialists in the hospital. Invariably that someone is the overworked, underpaid internist or family practice doc. So by all means, pay them more. Compensate them in such a fashion that will encourage more comprehensive, individualized care of their patients. But it can't be business as usual. If the reimbursements are going to be shifted toward the primary care docs, then there ought to be a concomitant shift in responsibility for the delivery of care and an increased awareness on the part of the PCP's of the cost of said delivery. No more shotgun consults. No longer ought it to be acceptable to admit patients at three hospitals (running up gargantuan inpatient censuses)in order to drum up revenues and then shunting the responsibility for the care of those patients onto specialists. Pay them more at the expense of consultants/proceduralists? Fine. We've seen this coming. But they're going to have to work harder, not in the sense of longer hours or greater effort, but in the sense of dealing with the practice of actual medicine on their own. That gastroenterologist perhaps isn't going to be as available ten years from now to help you out with that pain in the ass patient with chronic benign epigastric pain. And maybe the general surgeon won't be able to see that patient with a small infected sebaceous cyst stat like before. It sounds nice to better remunerate those primary care physicians who represent the backbone of the American health care system. But it won't come without a cost...