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Well, what do you know? Congress may finally be giving the doctors what they wantâsort of. As Campaign Desk has reported, doctorsâ groups have lobbied hard to eliminate the fee cuts set in motion more than a decade ago as a way to slow the governmentâs outlays for Medicare. The docs have successfully delayed the planned cuts nine times since 1997, and theyâve done it with a little help from their friends in the press.
A bit of background. In return for not blocking health reformâtheir customary stanceâthe 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 governmentâs 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 mediaâs story framing and choice of language has fit right well into the AMAâs lobbying strategyâthat is, to gin up outrage among patients and scare them into thinking they wonât get proper care. A âmassive cut,â said CNNMoney.com. âDoctors âŚunanimously expressed outrage,â said ABC News. âUncertainty over Medicare pay sets doctors on edge,â 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 reformâreducing 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 nationâs 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. Thatâs 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 donât 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 âvery few new Medicare patientsâ because Medicare pays too little. Weâve learned from USA Today about surveysâdone by the docs, of courseâshowing that docs are no longer participating in Medicare. Last year thirteen percent of survey respondents didnât, 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. Weâve 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 âhave left doctors frustrated,â and someâlike an Olympia, Washington, internist it profiledârefusing 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! Itâs striking how this people genre of reportage, so absent during health reform, has become the centerpiece for many of these âdoc fixâ 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 âvictims.â
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 cutâplus another one that the government did enact at the first of the yearâtook 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 âwoe is meâ doctor stories, why not give our suggestion a try. Once the docs get their increaseâand possibly more down the roadâcall up some of them and ask what steps theyâve taken to bring back their patients. If theyâve taken some, thatâs one story; if they havenât, thatâs quite another.
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