Editor’s note. These two items are taken from the invaluable NRLC blog: http://powellcenterformedicalethics.blogspot.com

Yesterday, the American College of Surgeons alongside 20 additional surgeon groups sent a letter to Senate leaders expressing major concerns with the health care restructuring bill.

Their intent is to put Senate Majority Leader Harry Reid (D-Nev.) on notice that the surgeons will oppose health care restructuring unless several key provisions in the Finance Committee's bill are removed or revised. One of these provisions that they point to is the "Death Spiral" provision. For other posts see http://powellcenterformedicalethics.blogspot.com/2009/10/medicare-doctors-patients-affected-by.html and http://powellcenterformedicalethics.blogspot.com/2009/10/wall-street-journal-warns-5-penalty.html.

Senate Majority Leader Harry Reid

As the letter explains it, the provision is "reducing payments to physicians who are found to have the highest utilization of resources -- without regard for patient acuity or complexity of the care being provided..."

Under the Senate Finance Committee health care restructuring bill, this "Death Spiral" provision mandates that doctors who authorize treatments for their Medicare patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year.

In the game of musical chairs, there is always one chair less than the number of players. So no matter how fast the contestants run, someone will always be the loser when the music stops. Similarly, under the penalty provision, a moving target is created--by definition, there will ALWAYS be a top 10%, no matter how far down the total amount of money spent on Medicare is driven.

It has also been reported that these groups (representing nearly a quarter of a million physicians) intend to bring up their complaints at this weekend's American Medical Association conference.

While adjustment may reduce the degree to which physicians are disproportionately penalized if they have sicker patients or work in high-cost areas, they do not change the fundamental danger of this provision, which (as explained above) is to create continual pressure on doctors to make ever-increasing reductions in the treatments and tests they order for their patients so as to avoid being in the penalized top 10%. The Congressional Budget Office rates this as taking almost $1 billion from Medicare payments over a period of 6 years. [See CBO 10/07/09 letter to Chairman Baucus.]

HOUSE VOTE ANTICIPATED THIS WEEK

The House will most likely begin debate on its health restructuring legislation Friday afternoon, allowing few, if any, amendments despite its many rationing dangers. A vote on passage could occur as early as Friday or Saturday but could slip to Monday or Tuesday of next week.

A "manager's amendment" (in this case 42 pages of technical and substantive changes to the bill, made in order to avoid the amendment process) was released Wednesday night. Rules Chair Louise Slaughter (D-NY) told reporters that Democrats intend to vote on the legislation on Saturday evening.

On the Senate side, Majority Leader Harry Reid (D-Nev.) has said that he won't rush things in order to meet a deadline. It has been reported that inside sources are indicating that although it is possible to compete a bill by the end of the year, it is more likely slip into 2010.

Part One
Part Two
Part Four