While relaxing with a glass of wine after a 12 hour day of spanking and cranking out 100’s of dictations, a Wall Street Journal article was brought to my attention. In reading it, my mental state stained the deep purple merlot with a brighter war-like red.
War!.....on Specialists!....am I a specialist? I asked, trying to decide whether or not I needed to be defensive…..
I read on.
The War on Specialists
ObamaCare punishes cardiology and oncology to finance GPs.
“Whew! I am neither of those two groups.” I thought.
WSJ: “……From Senate Finance Chairman Max Baucus's health-care bill to changes the Administration is pushing in Medicare, Democrats are systematically attacking specific medical fields like cardiology and oncology. With almost no scrutiny, they're trying to engineer a "cheaper" system so that government can afford to buy health care for all—even if the price is fewer and less innovative ways of extending and improving lives.”
The government is trying to engineer a cheaper system that it can afford….”by doing what?” you might ask….
WSJ – “Take a provision in the Baucus bill that would punish any physician whose "resource use" is considered too high.”
You mean “Punish” Cardiologists and Oncologists” who over-utilize resources???
WSJ – “physicians will be punished if he orders too many tests, performs too many procedures or prescribes too many drugs—whether or not the treatments result in better patient outcomes…...internists and family physicians will see higher payments on the order of 6% to 8%. …….in part because they're underpaid.”
Fair enough, I agree. This is not sounding like specialty warfare to me, this is sounding like someone finally awoke from their slumber and had a V8 moment.
WSJ – “But this boost for GPs comes at the expense of certain specialties. The 2010 rules, which will be finalized next month, visit an 11% overall cut on cardiology and 19% on radiation oncology. They're targets only because of cost….The chunks Team Obama took out of cardiology RVUs are especially drastic. The basic tools of heart specialists—echocardiograms (stress tests) and catheterizations—are slashed by 42% and 24%, respectively.
Oh….you mean the tools cardiologists have abused for years with skyrocketing utilization, caused by economically motivated self referral? Those tools?
WSJ- “Jack Lewin, who heads the American College of Cardiology, said in an interview that the crackdown will cause "a horrible disruption" that will force many community and independent practices to close their doors, lay off staff or make senior patients wait days or weeks for tests and services.”
Translation….”HOLY SHIT! ……THEY FINALLY GOT A BEAD ON US!....QUICK, BLAME THE RADIOLOGIST!”
WSJ – “Cancer doctors get hit because the Administration believes specialists order too many MRIs and CT scans. Certain kinds of diagnostic imaging lose 24% under new assumptions that machines are in use 90% of the time, up from 50%. There isn't a radiologist in America running an MRI 10.8 hours out of 12, unless he's lining up patients on a conveyor belt.”
I can see Dr. Lewin and the ACC Clan now, rubbing their hands, praying that smoke screen will continue to work. Let’s look at that a little more closely. Cancer docs get a hit because they order too many MRI’s, and CT scans. Then they suggest it is the radiologist who is running the scanners. Oh Contraire……It is the oncologist and cardiologists who are taking the hit because THEY OWN THE SCANNERS TO WHICH THEY ARE ORDING THE TEST BE DONE! Not the radiologist! THE RADIOLOGISTS DON’T ORDER TESTS! The punishment, my esteemed colleagues of the ACC, lies where it should, with the individuals ordering the tests. Don’t try to blame the radiologist. Only around 25% of “high value imaging” is actually done in a RADIOLOGIST’S office. The rest is done in hospitals, and in the offices of the self referrer.
The final insult to my intelligence was the following comments:
WSJ – “Markets are supposed to determine the composition of the workforce, not a command medical economy run out of Washington. It is perfectly insane to support one type of doctor by punishing others on a flawed theory about cost-control…..If Democrats are going to stomp on specialists, they should at least be open about it. Then again, all Americans might take a different view of health-care "reform" if they understood that it means snuffing out the best medicine.”
Free Market you say? Not a command economy you say? Be open about it you say? Let me ask you; is the ordering and delivery of medical imaging in America a free market? Who decides which imaging center, radiologists office, or hospital outpatient imaging center a patient goes to? Is it the patient? NO! It is the command economy of the SELF REFERRER that decides. It is the command economy of the IN-NETWORK insurance contract. It is not the patient who decides. Let me state this another way. I could be the best radiologist there is. Fellowship trained, highly skilled, well published, and with the most up to date equipment and protocols, the best service, and at the lowest price, and I am still RELIANT UPON ANOTHER DOCTOR TO SEND ME THEIR PATIENT. Let’s open up the markets! Let’s make them free and transparent! Let’s make the contractual arrangements you have with your leased scanners open to public scrutiny and the light of day. Let’s allow free competition for expertise, equipment, price, and services! LET’S FREE THE MEDICAL IMAGING MARKET. LET’S DRAW BACK THE CURTAIN! …….Are you afraid Dr. Lewin?
…..To the WSJ, Are you afraid of open markets, or just of fair reporting? Be careful who you listen to in this debate, least you be listening to the fox regarding the state of the henhouse.
Saturday, October 10, 2009
I've been so disgusted with the news on self-referral these days that I haven't bothered to post. But one of my partners, whom we shall call John Coolidge, authored the following piece based on a recent Wall Street Journal article. Read it and weep, especially if you are a radiologist.