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AMENDMENTS OFFERED TO REMOVE
“DEATH SPIRAL” MUSICAL CHAIR PROVISION FROM
BAUCUS BILL
WASHINGTON – Two
amendments are being offered to the healthcare
restructuring bill proposed by Senate Finance
Committee Chairman Max Baucus(D-Mt) to eliminate
a provision that penalizes Medicare doctors who
provide higher levels of medical treatment to
senior citizens.
“This provision creates
a cruel death spiral. By financially penalizing
Medicare providers, the Baucus bill sets up the
cruelest and most effective way to ensure that
doctors are forced to ration care for their
senior citizen patients,”
said David N. O’Steen, Ph.D, executive director
of the National Right to Life Committee. “Instead
of bureaucrats directly specifying the treatment
denials that will mean death and poorer health
care for older people, it compels individual
doctors to do the dirty work.”
Two amendments, supported by the
National Right to Life Committee – one offered
by Senator Jon Kyl (R-Az.) and one by Senator
Pat Roberts (R-Ks.) – would remove the provision
that establishes that for at least five years,
Medicare physicians who authorize treatments for
their 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 [see
footnote 1 at bottom of release].
This
means that all doctors treating older people
will constantly be driven to try to order the
least expensive tests and treatments for fear
that they will be caught in that top 10%. It is
noteworthy that this feature operates
independently of any considerations of quality,
efficiency, or waste - if you authorize enough
treatment for your patients, however necessary
and appropriate it may be, you are in danger of
being one of the 1 in 10 doctors who will be
penalized each year. Moreover, it creates a
moving target - 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's like a game of musical chairs, in which
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,” O’Steen added.
The incentive this creates is purely
cost-driven, without any balancing of benefit.
It will create a constant sense of uncertainty
in doctors, since none can know in advance
precisely what the cutoff for a given year will
be - resulting in still more pressure to limit
treatment and diagnostic tests to the bare
minimum.
“Creating a financial penalty
for doctors who seek to provide their patients
with the best, and therefore more costly,
treatment available, is a scary way to cut
costs,"
added Burke J. Balch, J.D.,
director of NRLC’s Powell Center for Medical
Ethics.
The Kyl Amendment #D2 is
amendment 125 and the Roberts Amendment #D1 is
amendment 137 in the Senate Finance Committee’s
markup of the Baucus bill.
For more information: http://powellcenterformedicalethics.blogspot.com
Notes:
1. On pages 80-81 of the
8.16.2009 Chairman's Mark, in the "Expansion of
Physician Feedback Program" in Title III,
Subtitle A, Part I; specifically, at the top of
page 81: "Beginning in 2015, payment would be
reduced by five percent if an aggregation of the
physician's resource use is at or above the 90th
percentile of national utilization. After five
years, the Secretary would have the authority to
convert the 90th percentile threshold for
payment reductions to a standard measure of
utilization, such as deviations from the
national mean."
The Congressional Budget Office (CBO) rates this
as taking $1 billion from Medicare payments over
a period of 6 years. See CBO 9/16/09 letter to
Chairman Baucus, Table, page 3 of 7.
The National Right to
Life Committee, the nation’s largest pro-life
group is a federation of affiliates in all 50
states and 3,000 local chapters nationwide.
National Right to Life works through legislation
and education to protect those threatened by
abortion, infanticide, euthanasia and assisted
suicide. |
