The Free Press, Mankato, MN


July 31, 2013

Change Medicare, and pricing

Why it matters: A bipartisan plan to bring more sense to Medicare price could save billions

Medicare has long been used in politics of fear campaigns by both parties, so a bipartisan bill to reform Medicare and bring common sense to its pricing comes as a welcome effort.

A bill moving through Congress would change the way doctors are paid at the same time remove some of the politics from the yearly vote to stop automatic cuts to doctor Medicare payments. The proposal to reform pricing is part of a larger bill that would also begin paying doctors for outcomes instead of the number of procedures they perform.

A recent investigation into Medicare pricing by the Washington Post offered plenty examples where an antiquated pricing system just didn’t make sense. It showed there were conflicts of interest on the board that sets Medicare pricing and prompted a thorough review. Now, we must move ahead with aggressive reform.

The Post found that the board that recommends pricing was made up only of members of the American Medical Association, a group of physicians but also one of the most powerful lobbying groups in the country. They were recommending the pricing their members receive. It’s a conflict of interest that defies common sense. There are plenty of other expert groups out there that could recommend appropriate pricing, yet for years it seems only the AMA was at the table.

The Post report also found problems with the pricing model. It has long been based on how much time it takes a doctor to perform a particular procedure. In one example, the Post reports that doctors were being paid for 75 minutes of work on a colonoscopy that in reality took only 15 minutes. In another case, the Medicare rates are set as if 41 percent of gastroenterologists do 12 hours of procedures a day, according to the Post report.

The bipartisan bill to institute the reforms also addresses in part the annual debate in Congress over the so called “doc fix,” — that regular overriding of Medicare cuts to physicians that typically cost taxpayers billions.

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