The Cost of Living, Part III

Are the docs really going to drop their patients?

Containing the runaway cost of medical care is the thorniest of all the thorny issues in the health-reform debate. There’s been tons of talk from politicians, advocates, and even health-care stakeholders about the need to reduce the nation’s rate of spending on medical treatment and keep a lid on price increases. Yet many policy experts say that the “acceptable” cost-containment options in the House and Senate bills are weak and will actually lead to more health-care inflation, which would mean that even more people could not afford insurance or care. It is a complicated, charged, and crucial issue; the press needs to dig in and own it. This is the third in a periodic series of posts that will scrutinize how well the press does that. The entire series is archived here.

Over the last few days, several news outlets have faithfully reported the medical industry’s anger over a measure that would reduce the amount the government pays doctors for treating Medicare patients. Horrors! If the docs don’t stop the long-delayed 21 percent fee cut, scheduled to take effect today, the sky will fall in—medically speaking, that is. Then again, the press reports the same thing every time the fee cuts are scheduled to take effect. And each time Congress comes to the rescue and stops the cuts, the press is there to record the victory. The Dance of the Fee Cuts has become a yearly ritual, with the media carefully following the steps.

The Naples Daily News in Naples, Fla. reported that physicians left their practices Friday frustrated at their elected leaders in Washington for failing to reverse the cut:

The fallout is physicians may scale back on the number of Medicare patients they treat and some may drop out of the Medicare program entirely. Physicians have been on pins and needles for sometime over the Medicare payment cuts and they didn’t expect it would go through because of extensive lobbying.

Dr. Joseph Gauta, president of the Collier County Medical Society, said that “This weekend you will see a lot of them sweating. Nobody thought this would take effect. They thought it would be fixed.”

Fixed? A fee cut to health care providers that could bend the cost curve everyone has talked about for two years now? It’s not likely Congress will let that happen, even though they voted for the schedule of cuts back in 1997 as a way to begin slowing the growth of medical costs in the Medicare program. The hope was that commercial insurers, which provide the kind of coverage the rest of us have, would begin slowing down costs on their end, too. Obviously that hasn’t happened for a lot of reasons, including the fact that the docs aren’t eager to give up any income.

The fee cuts concerned BusinessWeek, too, which talked to dermatologist Michael Bell of Murfreesboro, Tennessee. Bell said he had to delay appointments for his elderly patients by four months. Bell said that even if Congress steps in and blocks the cuts, Medicare pays too little. Were BusinessWeek readers to feel sorry for the dermatologists, who are among the best compensated medical specialists? The magazine quoted a Medicare official who said that Medicare pays 80 percent of the $65.67 cost of a mid-level office visit, but failed to say that most beneficiaries have supplemental coverage that pays the additional 20 percent. In the end, the docs get the full amount.

BusinessWeek also reported that the Mayo Clinic, showcased by the Obama administration as a model for other big hospital systems, said a primary care clinic in Arizona would stop taking Medicare patients Jan. 1 because the government pays too little. BusinessWeek’s story was dated February 26. Was the clinic still refusing Medicare patients? How many had gone untreated over the last two months? quoted from a letter that AMA president James Rohack sent his members about their options—including not treating new Medicare patients and leaving the Medicare program. According to CNN, physicians are asking the AMA to prepare handouts they can give to patients to prepare them for the worst-case scenario—getting dropped completely. CNN also tells us that the American Association of Neurological Surgeons is on the case. The association has done a survey showing that 65 percent of its 3,400 members said they were referring Medicare patients to other doctors, and 60 percent were reducing the number of Medicare beneficiaries that they would treat. One New York neurosurgeon said that consumers should prepare for some difficult days ahead.

Even a station in Brunswick County, North Carolina picked up the doctors’ lament. WECT based its story on the comments of the pediatrician who is president of the Brunswick County Medical Society. He said that everyone can make a difference in their health care coverage by calling local lawmakers.

Except for BusinessWeek, which made a small attempt to give another point of view, the stories ignored those who might want to talk about the cuts in a larger context—the effort to contain out-of-control medical costs. It would have been helpful had the stories reflected the reasons for the cuts, what they mean in terms of health reform, and how the AMA and the physician specialty associations have used the same lobbying tactics before to stop planned cuts.

A couple of months ago we saw the same kind of scary stories when the American College of Cardiology embarked on a media crusade to get the press to help them out. The cardiologists issued press releases to media outlets around the country featuring juicy quotes from local doctors about the grave consequences that were about to befall heart patients living in their areas. Campaign Desk pointed out that the stories sparked by the cardiologists were similarly one-sided and little more than PR for the docs. The Naples Daily News—yes, the same paper that Friday reported on worried and frustrated doctors, gave readers the same kind of story when the heart doctors wanted more money. Twice in a row? It’s not clear whether the paper knows or cares about the difference between flackery and balanced reporting.

In the summer of 2005, Luke Shockman, who at the time was the health reporter for the Toledo Blade, posed a question on the listserv of the Association of Health Care Journalists. Shockman wanted help finding someone other than a doctor to interview about the planned fee cuts for physicians. At the time, the AMA was in the midst of its successful House Calls campaign to news organizations: visiting editorial boards, taking out ads, and holding press conferences to convince reporters that fee cuts were not warranted. AHCJ asked the larger question: How do journalists perform their role as educators of the public without playing into the hands of the special interests—in this case, doctors who want more money from a program facing long-term financial problems. That is still the question.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.