“There’s a right way and a wrong way to achieve healthcare reform,” Sen. John A. Barrasso, MD (R-Wyo.), told the members of the Board of Councilors (BOC)/Board of Specialty Societies (BOS) at their fall meeting. “We don’t need to destroy a system that works pretty well for most people. We do need to have a patient-centered focus, as opposed to a government-centered or insurance-centered bill.”
Sen. Barrasso, the only orthopaedic surgeon in the Senate, was resolute about what he considered important in any healthcare reform measure: enabling people to shop across state lines for insurance and get what’s right for them; giving individuals the same tax advantages as companies; providing wellness-focused programs for individuals; including tort reform and a permanent fix to the Medicare sustainable growth rate (SGR) formula.
“I’d rather we do this right than do it fast,” he said. “I want to make sure that whatever passes does the least amount of harm to the system and the people who take care of patients.”
Although he spent most of the time responding to questions from the packed room, Sen. Barrasso did discuss the constantly shifting shape of healthcare reform, and, in particular, the Medicare Physician Fairness Act of 2009 (S 1776), which would have repealed the SGR formula, eliminated all accumulated debt under the current payment system, and indefinitely frozen reimbursement rates at the current levels. Subsequent to Sen. Barrasso’s appearance, the bill came up for a cloture vote (vote to limit debate and allow the bill to proceed) and was defeated by a vote of 47 ayes to 53 nays.
“We still don’t know what’s in the Finance Committee bill or what healthcare reform will look like when that bill is blended with the one from the Health, Education, Labor, and Pension (HELP) Committee bill. We need an extended discussion on this issue.”
Admitting that “absolutely, something is going to be passed and signed into law,” Sen. Barrasso expressed hope that the Senate would not be constrained by “false deadlines” to get something done.
“Senate rules would require 60 votes,” he explained, “but issues that have to do specifically with budgeting can pass with just 51 votes. If you’re going to change one-sixth of the economy, something that affects everybody in the country personally, you ought not to jam it through by one vote. If there’s that much concern and disagreement, we ought to work to get it right.”
Sen. Barrasso complimented advocacy efforts by the American Association of Orthopaedic Surgeons (AAOS), noting that the orthopaedic community is “present and powerful” in Washington, D.C. He pointed to the fact that the Orthopaedic Political Action Committee (PAC) has surpassed the American Medical Association’s PAC in fund raising this year. Regarding its position on reform, he said, “the AAOS is absolutely right.”
After his initial remarks, Sen. Barrasso responded to a number of questions from BOC/BOS members.
When asked about the constitutionality of a universal coverage requirement, Sen. Barasso pointed out that 12 states have already said that they want to “opt out.” Many state governors, he said, fear that such a mandate would force individuals into Medicaid programs and bankrupt states. He also expressed concerns about access, noting that about 40 percent of physicians in America don’t accept Medicaid patients because the reimbursements are so low.
The impact of reimbursement on physician supply was also raised, particularly in the context of legislators’ understanding of physician payments. BOS representative David A. Wong, MD, a spine surgeon, shared the following story:
“I asked a senator’s senior health policy advisor how much he thought surgeons received for doing a spinal laminectomy—day of surgery, the procedure itself, and 3 months of follow-up care—and he thought we got $10,000!” In fact, physician reimbursement for code 63047 is more like $1,000 (depending on the region).
“You can’t keep the doors open at that rate,” agreed Sen. Barrasso. “Legislators aren’t dumb, but they don’t have the practical experience. When I tell my colleagues that my group was paying $365,000 a year in medical liability premiums—that’s $1,000 a day—they’re stunned.”
“Why won’t the government let doctors deduct their losses, when patients can’t pay?” asked Larry L. Pack, MD, a BOC representative from Michigan. It’s a question that Sen. Barrasso has also asked.
“I thought my time was worth something,” he said. “I find it fascinating that if I apply a cast or provide a brace to someone who can’t pay, I can write off the cost of the cast or brace, but my time isn’t worth anything…and that’s still the case, now that I’m an elected official,” he joked.
Several fellows raised concerns about the Recovery Audit Contractor (RAC) program. Established under the Medicare Modernization Act of 2003, RACs are charged with identifying improper Medicare payments—both overpayments and underpayments. RACs are paid on a contingency fee basis, receiving a percentage of the improper overpayments and underpayments they collect from providers. During the program’s demonstration years, nearly 96 percent of the errors identified were overpayments to providers, who not only had to refund the overpayment but were also subject to fines. A provision in the Senate Finance Committee bill would extend the program to Medicaid, Medicare Advantage, and Medicare Part D programs.
At least one comment garnered applause from the audience. Kurt F. Konkel, MD, a BOC representative from Wisconsin, asked, “Why not just let Congress implement the 21 percent reduction? Doctors would drop out of Medicare, people would rise up, Washington would convulse, and things would change instantly.”
Sen. Barrasso agreed. “Talk beyond the medical community,” he urged. “Talk to your patients…they’re the ones who will rise up and tell Congress to stop.”
Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at email@example.com