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July 11, 2008

Dodging this Week's Medicare Bullet

On Wednesday, Congress staved off 10.6% cuts to Medicare reimbursements. We thought we'd tour DC to see how local docs affected, or were affected by, the outcome.


Stuart "Say it Like it Is" Seides, Washington Hospital Center


Cardiologist Stuart Seides had a unique approach to fight the Medicare cuts. Yes, he's sits on the board of director of Medstar, and is a past-president of the Medical Society of DC, but considering some members of Congress are his patients, one particular skill came in handy: "I'm not afraid to lobby people when they're naked."


Stuart, like many, faced stark decisions in the days between the June 30 deadline and Wednesday's vote. If the vote failed, he told us the balance between a doctor's moral and ethical desire to accept Medicare and the fiscal reality of running a business would have tipped in an unpleasant direction. A 10.6% reduction would have left him unable to see new Medicare patients and he'd eventually have to consider dropping out of the program, something his practice, Cardiology Associates, P.C., has never done.

Jack "Bonus Army" Lewin, CEO, American College of Cardiology


On Wednesday morning, American College of Cardiology CEO Jack Lewin proved deserving of that key to Sausalito, CA, by correctly predicting the outcome of the 4pm vote. He also told us the ACC is looking past this crisis (though not forgetting the disrespect) so they can push a bonus-based compensation plan to one day replace the Standard Growth Rate at the root of this annual problem. Awarding bonuses to physicians who electronically report on the quality of their care is not new—doctors already receive a 1.5% reward on Medicare reimbursements if they use the Physician Quality Reporting Initiative—but Jack says a 5% bonus would more appropriate. Many ACC doctors already report, but all are being encouraged to participate.


For its part, the ACC has increased its output of Clinical Decision Support, evidence-based guidelines for docs to measure their practice against. One example: they recently alerted hospitals to the 90-minute window they have to reperfuse heart attack victims before risking permanent muscle damage. (The average door-to-balloon time was 2 hours.) Implementing Clinical Decision Support is very difficult without switching to electronic medical records, but Jack says cardiologists' 50% EMR adoption rate puts them ahead of most specialists.

David "Need a Better Business Model" Borenstein, Treasurer, American College of Rheumatology


Of course, the ACC isn't the only association with a stake in Medicare. For another perspective, we interrupted American College of Rheumatology treasurer David Borenstein right in the middle of something important. (Or benign. Hard to tell since we read X-rays at a 2nd grade level.) He says the ACR had to expend resources to keep doctors informed on best practices in the event they could not afford to see new Medicare patients including what to tell other doctors who continued to refer them patients. Despite Wednesday's vote, David says the underlying faulty payment formula has students questioning the value of spending 10 years in school only to enter into an unworkable business model.


For the sake of everyone's sanity, we'll end on a positive note. David tells us ACR's e-mail list serve was very effective in keeping the nation's rheumatologists informed. For example, he was able to monitor the efforts of a set of doctors in Georgia as they pressed their Senators. In the end, both Sens. Chambliss and Isakson changed their votes. We have no empirical evidence suggesting it was ACR who actually flipped them, but we promise we won't publish these findings without peer review. David, for one, is always up for some publishing: His most recent article was in Rheumatology and it's an epic look at spinal stenosis. No plans for a movie deal at this time.

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