While health care reform is in limbo, we do need some form of health care legislation to pass in order to prevent a looming cut to Medicare reimbursement for physicians at the end of February. We understand that Senate leadership and the chairmen of the Finance and Budget committees are working to try to include a fix to the Medicare physician payment formula as part of legislation being considered to increase the federal debt ceiling.
While details have not been confirmed, but the deal being discussed reportedly includes a 5-year exemption from the pay-as-you-go rules for a physician pay fix. The plan also includes creation of a deficit reduction commission, which would make recommendations to Congress on how to proceed with reducing the federal debt. The commission's recommendations would be put to congressional vote for approval. There is disagreement within Senate leadership on the creation and scope of the commission, and some leaders support creation of such a commission via executive order instead of legislation. The physician pay fix could have a modest increase to Medicare fees but all of the scenarios are very modest at this point. Without congressional action, a 21.2 percent cut to the fee schedule is scheduled to kick in at the end of February making this a critical health care issue that must be addressed regardless of other health care legislation.
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Another element that is not being addressed in all this is the cost of medical education which is on the verge of topping $200,000 to become a licensed physician. Medical school tuition cost is increasing at an alarming rate each year with no end in sight. If health care reform can't pass without adequately addressing physician pay...it cannot pass without adequately addressing educational costs. It is a HUGE consideration when some medical students begin to choose a specialty and why some student opt away from primary care. NO, it's not all about the money. The general public, politicians and those driving the reform cannot point the finger and say physicians are not being altruistic when policies so severely restrict a physician's ability to pay off a tremendous debt. Altruism is a nobel thing when the cost of such sentimentality is managable. However, it approaches lunacy when a physician must run the risk of bankruptcy and watch his own love ones suffer as he takes care of others because he cannot afford to provide for his own family. And if politicians say that they're talking all this into account as well, they're not being entirely truthful. Recent legistlation was inacted that removed a resident's ability to defer federal education loans while in Residency, leaving only forebearance as an option. What this means is a Resident's student loans are still accruing interest while in residency. This may not be a big deal if the loans are relatively small. But, if the loans are $150,000-$200,000 carried over a 3-year period (the shortest residency available)...the increase to debt-load increases to increadible amounts. Yet, that is what politicians felt was acceptable. This in conjunction with recent cuts in Medicare reimbursement leads one to ask, "Are those pushing reform in Washington D.C. really looking at the big picture? Are they going to pass legislation that makes sense?" In my eyes, the answer is "No."
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