You are listening to ReachMD, the Channel for Medical
Professionals. Welcome to GI Insights where we cover the latest clinical
issues, trends, and technologies in gastroenterological practice. GI Insights
is brought to you by AGA institute and sponsored by Takeda Pharmaceuticals
North America.
Your host for GI Insights is Professor of Medicine at University
Of Illinois, Chicago, Dr. Jay Goldstein.
Changes are on the horizon for the White House and for
Medicare where physicians continue to see their pay cut by Medicare and what
else do physicians need to know about their approach to Medicare in the years
to come. Joining us to discuss updates, new developments in reimbursement in
Medicare is Dr. Carla Ginsburg, Assistant Clinical Professor of Medicine at
Harvard Medical School and a Practicing Gastroenterologist in Newton,
Massachusetts. Dr. Ginsburg is also the Private Practice Counselors on the
Governing board of the AGA.
DR. JAY GOLDSTEIN:
Welcome Dr. Ginsburg.
DR. CARLA GINSBURG:
Thank you.
DR. JAY GOLDSTEIN:
Well, I want you to give us a little of historical
prospective. Why over the past two years our physicians constantly dealing
with Medicare cuts?
DR. CARLA GINSBURG:
To briefly summarize this, decrease reimbursements to
doctors occurs automatically and really this is because of a flawed formula,
which is called the SGR or the sustainable growth rate but that reduces
Medicare payments to doctors whenever the growth in spending of
physician-related services exceeds the gross domestic product, so the culprit
really is that there is a total expenditure target that’s set by Medicare, and
when total spending is above the target, reimbursement decreases and this
really has been the case over the past 8 years. Its now working because there
are many facts, which affects expending by doctors, which really are beyond our
control, I mean such as aging population, changes in practices driven by tort
reform, or mandated welcome to Medicare visits.
DR. JAY GOLDSTEIN:
What about technology?
DR. CARLA GINSBURG:
It takes definitely a new screening, changes in lots of new
screening just like colonoscopies, I mean is a new screening as of you know
within the past 5 years or so and technology driven, its true, all these
factors are beyond our control, but there are not taking into account with the
formula.
DR. JAY GOLDSTEIN:
Well, I know it is very hard to predict the future, but I am
going to ask the question. What’s going to happen to physician payments in
2009?
DR. CARLA GINSBURG:
Okay. Well, just to give you again a slight background,
payment cuts were scheduled to occur in July 2008, July 1st actually, but on
July 9th, the senate in a very bitterly part as an dispute passed, what they
called the Medicare bill, and this bill actually canceled the payment cut that
had been scheduled to occur at July 1st and really used the Medicare advantage
program which is a major source of funding for the fix and while Bush rewrote
the bill because it would reduce federal payments to the Medicare advantage
plan. The House in Senate overwrote the veto and the 10.6% payment cuts was
averted. That’s when Senator Ken re-appeared in Congress, which you might have
read about. This was all in July, so but now in 2009, this new Medicare bill
provides an 18 months’ remedy to the proposed cuts and we get now 1.1%
increasing payments to all doctors in 2009, but actually gastroenterologist
will receive 3% more and this includes really a 2% increase in practice
expenses due to an application of a survey, which was provided by the AGA
actually and some other societies. So we are actually going to get a 3%, but
its thin, its in 18-month fix.
DR. JAY GOLDSTEIN:
Really at the end of 18-months?
DR. CARLA GINSBURG:
We have to go for another fix. I mean unless something
changes, we will have a decrease to 5% and over the next 10 years, if things do
not change, it will be 40% decrease in reimbursement.
DR. JAY GOLDSTEIN:
Are there other provisions in this Medicare bill that our
listeners should know about?
DR. CARLA GINSBURG:
Ya. I mean there are about 3 basic other provisions. One
is, it is going to extending the physician quality reporting initiative which
is called the PQRI until January 01, 2011, and that increases our bonuses to 2%
if we do this, and actually a PQRI fund has been created to set aside money to
pay doctors for this and there is apparently 5 billion available to 2013. The
other thing it provides is bonuses to those doctors who do e-prescribing
between 2009 and 2011 and penalty once e-prescribing becomes mandatory, which
it does in 2011 and also it requires facilities performing advanced diagnostic
imaging services to be accredited by January 1st in order to be eligible for
the technical component of the Medicare payment.
DR. JAY GOLDSTEIN:
Accredited by whom?
DR. CARLA GINSBURG:
By the government actually Medicare, the CMS.
DR. JAY GOLDSTEIN:
Well. It sounds to me like we are on a roller coaster, up
and down.
DR. CARLA GINSBURG:
Yeah, and it’s like I said over the past 8 years, we have
been getting decreases, but there has always been a fix every year, so that we
actually didn’t see the decreases. It’s always been either the same or may be
a percentage increases or so, but it has been up and down for the past 8 years.
DR. JAY GOLDSTEIN:
Well, we don’t live in a vacuum, so when are the factors
actually are going to affect reimbursement in years to come?
DR. CARLA GINSBURG:
Sure. Well, besides for that flawed formula, there are
other factors. Due to its shortage of primary care doctors and what’s been
called the crises in primary care, many are calling for a fundamental change in
the way primary cares delivered in finance actually, and this new model, which
you might have heard of, is called the Patient-Centered Medical Home and it
links patients to a personal physician who provides improved communication and
comprehensive care in a practice that actually has to qualify as a Medical Home
and the problem is a revised reimbursement model based on 4 separate payments
has been proposed for this and the possibility does exist that money to support
this initiative will be taken away from the specialists, so that’s the
problem. In addition, the new reimbursement system for the ambulatory surgical
centers with the ASCs ties ASC reimbursement to 65% of the Hospital Outpatient
Department and this is a big drop for us. Since the new system must be budget
neutral, the system is nearly a redistribution of funds away from specialties
with higher payments, which we have had. So this is a decrease ____ as well.
DR. JAY GOLDSTEIN:
Lets review that for a second, the ASCs will get reduced
reimbursement?
DR. CARLA GINSBURG:
Yeah, because ophthalmology and GI were getting maybe I
think it was in the 80s of the Hospital Outpatient Department and because of
this new reimbursement system for ASCs, now its going only to be 65% of the
Hospital Outpatient Department and this has been starting to facing and I think
it was this year already they are facing this since, so the people who have a
fees are getting less now.
DR. JAY GOLDSTEIN:
And will be getting less in the future?
DR. CARLA GINSBURG:
Yes. Down, once it hits 65%, its going to be held at that
via Hospital Outpatient Department, but it definitely is a decrease in payments
for GI and Ophthalmology.
DR. JAY GOLDSTEIN:
That will significantly affect many of out practicing
gastroenterologists.
DR. CARLA GINSBURG:
The HEI has actually been advocating to change this. We
have been trying to change this, but it is hard because its just GI and
Ophthalmology that really would like to have this changed and I don’t it will
be.
DR. JAY GOLDSTEIN:
Well, lets move a while for second here. You know, the
elections were recently concluded, we have a new President Elect, what do you
think are the key points of his new Medicare plan? How will it affect
gastroenterologists?
DR. CARLA GINSBURG:
Well. President-elected Obama actually sees the Medicare
physician payment system as really part of a larger problem and must be
reformed along with part of a comprehensive health reform. He really does not
want to just zero in on this one issue without bigger fixes. So his plan would
require obviously greater transparency around quality and costs, and requiring
providers actually to collect and publically report measures of healthcare
costs and quality. I think that the healthcare analysts expect the new President
and Congress to undertake really a sweeping overhaul of the healthcare
industry, not very soon. I don’t think it is expected because I think the more
pressing needs of the economy make it unlikely that really big changes in
healthcare can quickly make their way to the top of the agenda. I think many
analysts expect Congress to take some steps to address the increasing costs of
medical care and I think high on the list is covering more children under the
____ State children's health insurance program and I think however they might
also try some relatively inexpensive other changes which would affect us like
pushing harder for the adoption of electronic health records or requiring
hospital and doctors to report publically both the costs and outcomes of their
care and set up to enable patient to comparison shop. I think that’s going to
be big changes.
DR. JAY GOLDSTEIN:
If you just tuning in, you are listening to GI Insights
on ReachMD XM160, the Channel for Medical Professionals. I am your host, Dr. Jay
Goldstein, and joining me today to discuss an update on the newer developments
in reimbursement in Medicare is Dr. Carla Ginsburg, Assistant Clinical
Professor of Medicine at Harvard Medical School and a Practicing
Gastroenterologist in Newton, Massachusetts. Dr. Ginsburg is also the Private
Practice Counselor on the Governing board of the AGA.
Let me kind of summarize something here. Less
reimbursement, more quality reporting, e‑prescribing, e-medical records,
each coming with a cost at lower reimbursement.
DR. CARLA GINSBURG:
Right, exactly.
DR. JAY GOLDSTEIN:
How does this workout financially for the
gastroenterologist?
DR. CARLA GINSBURG:
Well, this doesn't look good, I mean if things don't change,
there is going to continue to be temporary fixes by the government and
decreases in physician reimbursement because as we said before and to the
current formula, physicians, they are going to face cuts of probably more than
5% a year and between up to 2012, more than 40% over the next 8 years. I mean,
I think the physician reimbursement is becoming more closely linked to quality
measures and costs, and this is going to be a problem, and AGA actually and all
of medicine has to advocate for the new administration to bring Medicare
payment system reformed to the forefront and well actually over the past year,
the Senate finance committee met with the AGA and other specialty organizations
and they assured us that they would address the funding mechanism more broadly
in 2009, but that does remain to be seen.
DR. JAY GOLDSTEIN:
DR. CARLA GINSBURG:
DR. JAY GOLDSTEIN:
I would like to thank my guest from Harvard Medical School,
Dr. Carla Ginsburg:, who is in Private Practice and the Private Practice
Counselor on the Governing Board of the AGA. Dr. Ginsburg, thank you very
much for being our guest this week.
DR. CARLA GINSBURG:
Thank you. Thanks very much.
You have been listening to GI Insights on ReachMD, The
Channel for Medical Professionals. GI Insights is brought to you by AGA
Institute and sponsored by Takeda Pharmaceuticals North America. For
additional information on this program and on‑demand podcasts, visit us
at Reachmd.com and use promo code AGA.
Takeda Pharmaceuticals North America is proud to sponsor
this important and quality programming for ReachMD listeners. Takeda does not
control the editorial content of this broadcast. The views expressed are
solely those of the guests who are selected by the AGA Institute. Based in
Deerfield, Illinois, Takeda Pharmaceuticals North America is a wholly owned
subsidiary of Takeda Pharmaceutical Company Limited, the largest pharmaceutical
company in Japan. In the United States, Takeda markets products for diabetes,
insomnia, wakefulness and gastroenterology and is developing products in the
areas of diabetes, cardiovascular disease and other conditions. Takeda is
committed to striving toward better health for individuals and progress in
medicine by developing superior pharmaceutical products. To learn more about
the company and its products, visit www.tpna.com.
