When the Doc Fix Is in, Will Everything Be Ok?

Larry Culpepper, MD, MPH


March 21, 2011

In This Article

Editor's Note

The Affordable Care Act (ACA) was signed on March 23, 2010, and introduced a year of hope, anger, controversy, and confusion. Although addressing the issues of Medicare reimbursement and the unsustainable sustainable growth ratio is not officially part of reform legislation, it is clear to anyone engaged in the health profession, that the "doc fix" is an essential component of its success or failure. Three members of our primary care roundtable eloquently took on the subject in the context of this long and contentious year.

Robert W. Morrow, MD: We Need the Doc Fix Now

"Wouldn't it be nice if childcare were funded and the military had to hold bake sales to support new bombers."

How we set healthcare on a stable foundation economically and have happy docs and patients is relatively easy to imagine. It has little to do with a "doc fix," and yet everything.

First, build primary care aggressively.

All of the world's health systems structured this way cost far less and have better population results, happier doctors, and the tools to deal with technology introduction.

The US healthcare system has failed miserably because the more expensive care is the higher the incomes of those with the interest to drive it higher -- health plans, large institutions, pharmaceutical companies, and their financial backers.

For years, the enablers of these organizations in the subspecialist physician community have driven up fees for technologically driven procedures with scant evaluation or benefit to the public. The American Medical Association and their Relative Value Scale Update Committee (RUC) leap to mind, pushing primary care payments into the muck.

Why? Because good primary care doctors know they must see their patients and protect them. That means far fewer procedures and admissions, as the most cursory look at the literature shows. Happy patients, happy communities, happy doctors.

Should proceduralists get a doc fix? Let's just say no.

Should the ACA be allowed to put limits on health plan profits and exclusionary policies? Yes, but how about making the limit on the loss ratio 150% of Medicare, not the 300% as stated in the ACA. How about cutting Medicare Advantage Plan premiums to par with Medicare? These moves would pay for the rent of the primary care patient-centered medical home.

As for Medicaid, a large percentage of its costs go for long-term care, which is not on the table. Our fees as physicians make up a fraction of this total. Cutting primary care fees quickly raises total costs. Building patient-centered primary care homes lowers costs consistently, usually by a third or more.

A doc fix for primary care is what we need -- right now.


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