The Docs and the Press

What a little help from their friends will do

Well, what do you know? Congress may finally be giving the doctors what they want—sort of. As Campaign Desk has reported, doctors’ groups have lobbied hard to eliminate the fee cuts set in motion more than a decade ago as a way to slow the government’s outlays for Medicare. The docs have successfully delayed the planned cuts nine times since 1997, and they’ve done it with a little help from their friends in the press.

A bit of background. In return for not blocking health reform—their customary stance—the docs thought Congress would get rid of the payment formula once and for all, thus stopping this round of cuts that would have reduced Medicare reimbursements some 21 percent. But Congress balked, because the cost of the fix, $210 billion over ten years, was too high, and would have sent the government’s health reform expenditures way over the $900 billion or so that the president said was his line-in-the-sand price tag.

So the cuts got postponed and postponed. In the last several weeks, they got tangled in Congressional deficit hysteria, and members had another reasons for not letting the docs off the hook. This week, the Senate voted for a six-month reprieve and gave the docs a 2.2 percent raise. (The House agrees with the Senate.)

The doctors must be pleased as punch that the media’s story framing and choice of language has fit right well into the AMA’s lobbying strategy—that is, to gin up outrage among patients and scare them into thinking they won’t get proper care. A “massive cut,” said “Doctors …unanimously expressed outrage,” said ABC News. “Uncertainty over Medicare pay sets doctors on edge,” screamed a headline on an AP story.

If these stories were long on scary phrases, they were short on context, background, and any explanation of how all this meshes with a major goal of health reform—reducing the growth rate in health care spending. There were repeated quotes from AMA leaders talking about a broken payment system, but little discussion about what needed to be fixed, and what that would do for doctor payments and the nation’s total health care bill. There was no acknowledgement that when fees are cut doctors simply find a way to make them up elsewhere, like demanding higher payments from commercial insurers. That’s the story that Reed Abelson of The New York Times told very clearly last week. She pointed out that when Congress tried to reduce spending for chemotherapy drugs, many docs simply prescribed chemo for more patients to make up for the lost revenue. Some physicians even switched to more expensive drugs. But Abelson is an anomaly. Most outlets don’t talk about this stuff.

Instead, the media has given us threats from the doctors. North Carolina primary care doc Susan Crittenden told the AP that her practice takes “very few new Medicare patients” because Medicare pays too little. We’ve learned from USA Today about surveys—done by the docs, of course—showing that docs are no longer participating in Medicare. Last year thirteen percent of survey respondents didn’t, according to the American Academy of Family Physicians; fifteen percent is the number from the American Osteopathic Association; the AMA comes in at seventeen percent. We’ve had stories about doctors and their sagging finances, which will only get worse if fee cuts go forward. Kaiser Health News told the stories of how six doctors will cope if the fee cuts stand.

The Wall Street Journal reported how short-term fixes “have left doctors frustrated,” and some—like an Olympia, Washington, internist it profiled—refusing to take new patients. The doc said he was thinking of quitting his practice and moving to Chicago, where his wife could resume her sales job. He would become a stay-at-home dad. What a predicament! It’s striking how this people genre of reportage, so absent during health reform, has become the centerpiece for many of these “doc fix” stories. All of which raises the question whether physician organizations are using a story bank they have compiled and are passing names along to reporters, making it easy for them to find “victims.”

The cardiologists did that earlier this year, when the American College of Cardiology sent out news releases featuring local doctors and practices that were in deep trouble, and would continue to be if the 21 percent cut—plus another one that the government did enact at the first of the year—took effect. There were the familiar threats to cut services, reducing staff, and so on.

Whatever the outcome in Congress this week, the AMA is displeased, and its new president, Cecil Wilson, is sounding tough. That could mean a heightened interest in using the media. But before news outlets send their reporters out to do any more single-sourced “woe is me” doctor stories, why not give our suggestion a try. Once the docs get their increase—and possibly more down the road—call up some of them and ask what steps they’ve taken to bring back their patients. If they’ve taken some, that’s one story; if they haven’t, that’s quite another.

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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.