DEATH SPIRAL REMAINS AFTER PARTY-LINE VOTE

Kyl Amendment defeated 13-10 in Senate Finance Committee

WASHINGTON – In a 13-10 party-line vote last night, the Senate Finance Committee rejected an amendment by Senator Jon Kyl (R-Az.) to remove a provision in the health care restructuring bill establishing 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.

“Last night’s vote in the Senate Finance Committee should put America’s senior citizens on alert: if the death spiral provision actually becomes law, their Medicare providers will start a race to the bottom to avoid being captured in the top ten percent,” said Burke Balch, J.D., director of National Right to Life’s Powell Center for Medical Ethics. “Older Americans who rely on Medicare would be faced with fewer and less-effective treatment options. This is among the most insidious provisions for rationing in any of the health care bills before Congress."

The provision, on pages 80-81 of the "Chairman’s Mark," (documentation available here) drives all doctors treating older people to try to order fewer and less effective 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,"  Balch said.  "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."

As National Right to Life Executive Director David N. O’Steen, Ph.D., has previously noted, “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.”

As I try to think about putting … my feet in the shoes, of a doctor who might be treating Medicare patients facing this construct, it is one thing to have the feedback, I think we should absolutely… I think we should do that. But I think this putting in a penalty that really leaves me cold.  I don’t know how you separate out overutilization that is really overutilization from those doctors who may have a group of patients who require more treatment than another group of patients and when you’re put in the position of, there is no way of knowing as you go through the year what is going to happen at the end of the year. And so what do any doctor who wants to avoid being in this penalty box have to do? …I think this, this is one part of this that I think we should think long and hard about.  There is no way of knowing when you go through the year, what you are going to do at the end of the year.

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.