Dr. Donald Eberly: Medicare cut would reduce NH's access to doctors

By DR. DONALD EBERLY
http://www.unionleader.com

AS A GENERAL SURGEON who performs a wide variety of highly technical procedures, I would hardly come to the operating room wielding household scissors and a pair of pliers. My patients and medical colleagues would react in horror, and rightfully so.

With the modern era of sophisticated surgical precision, none of us would consider resorting to such crude methods for the most basic reason: Better tools and procedures exist that greatly improve the outcome for our patients.

Why, then, would our elected officials fail to stop a similarly crude attempt to rein in Medicare costs — namely, the 10.6 percent across-the-board cut that went into effect July 1?

For six years, Congress has unsuccessfully struggled to fix the complex formula behind this dangerous slash in provider fees. By failing to pass the bill that would have reversed this cut, Congress tacitly endorses the use of a blunt force instrument at a time when accurate and intelligent tools are emerging that can reduce costs without sacrificing quality health care.

After receiving overwhelming approval of the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331) from the House of Representatives, the bill failed in the U.S. Senate by one vote. Sen. John Sununu was one of those “no” votes. His concern was that the bill would result in some seniors being dropped from Medicare Advantage, a federally subsidized “HMO-type” private plan. Studies show that while Medicare Advantage plans provide a few extra benefits, they also cost the federal government substantially more than traditional Medicare.

Unquestionably, the consequences of a 10.6 percent pay cut will limit access to health care for the elderly and disabled. Many physicians have already said that if this goes through, they will have to limit the number of Medicare patients they take on or risk closing their practice.

But the impact goes beyond immediate access to physician services to include any of us who live, work or travel in rural areas, such as northern New Hampshire. What people aren’t talking about — and should be — is that the Medicare cut will exacerbate a growing shortage of physicians and surgeons. Nowhere does this impact hit harder than when a rural community lacks surgical services.

Not only does the surgical work-force shortage problem affect access to surgical services and the survival of rural hospitals, but it also limits patient access to trauma care.

Everyone agrees that we must find ways to spend Medicare dollars more effectively and efficiently. To its credit, Medicare and many other health and medical experts are looking to adapt principles used in science to identify the best ways to improve care while cutting costs.

Just as we use evidence, data and experience to identify the best ways to provide focused surgical care while having minimal impact on our patients’ overall well-being, Medicare is adopting similar approaches to guide reimbursement decisions.

For instance, for the last two years, the Dartmouth-Hitchcock Clinic in New Hampshire has been among 10 large group practices participating in a Medicare demonstration project to deliver better care and save money. The program has shown promising results by assisting cancer patients and their families in coordinating their complex care, helping patients to follow hospital post-discharge instructions, making appropriate follow-up appointments and ensuring patients understand all medications and exact dosages.

While these aspects of care may seem simple, this is not the case for a parent or grandparent trying to fight cancer. These “simple” tasks get confusing and frustrating when multiple doctors and care-givers are involved. This New Hampshire program, and others like it across the country, employ more precise, strategic and cost-effective strategies to help rein in health care costs without resorting to the injurious “blunt force” approach of an arbitrary across-the-board cut.

Today, the U.S. Senate will likely try again to pass a bill that will stop the 10.6 percent cut. Another “no” vote from Sen. John Sununu makes about as much sense as pliers in the operating room: bottom line, we can do better. Sununu should vote to block this across-the-board pay cut and shift his support to ongoing Medicare efforts to control costs by identifying and paying for high quality medical and surgical services that bring the greatest value to New Hampshire’s seniors.

Dr. Donald Eberly, a general surgeon, practices in New London.

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