Reform starts by changing the way we pay physicians


From Indian medicine men to frontier “saddlebag docs,” Texas has a long, rich history of pioneers in medicine. Early Texas physicians often met the medical needs of entire families, traveling long distances on horseback just to provide care.

In more urban settings, such as Galveston, physicians began renting facilities for patients to visit. In 1851, Samuel Hurlbut contracted with the city of Galveston to become the physician for the state’s first civilian hospital, treating 250 to 500 patients each year.

In San Augustine, famous Texas Ranger John S. Ford also worked as a family physician. According to medical records in 1844, Ford charged $15 for delivering a baby, $7 for bloodletting and 75 cents for an “itch ointment.”

These days Texas is home to some of the world’s elite research centers, hospitals and medical schools. The University of Texas Southwestern Medical School employs more Nobel laureates than any other medical school in the world, while Houston’s Texas Medical Center houses 13 prestigious hospitals.

From humble beginnings, Texas has made incredible strides in medicine. However, without immediate reforms to the way our government pays physicians under Medicare, we can expect a major decline in the number of physicians available and an ever higher spike in the cost of care.

These negative trends have already begun. A decade ago, Congress tried to curb rising health care costs by implementing an arbitrary cap on physician payments. As a result, physician reimbursements across the country lag far behind actual practice costs. In Texas and across the nation, the gap between physician reimbursements and the costs for delivering care is roughly 15 percent.

To make up the difference in revenue, many physicians have crowded their waiting rooms with extra patients, resulting in rushed visits, less one-on-one time and a lower quality of care.

Texas already has a low physician-to-population ratio, and declining reimbursements will only discourage future generations of physicians. The Association of American Medical Colleges estimates the average debt for medical school graduates at $139,517. With more than 85 percent of graduating medical school students carrying debt, news of insufficient reimbursement rates could dissuade would-be medical students from pursuing the profession.

While many are calling for health care reforms to cover the uninsured, we must first ask ourselves the important question: What good is coverage without access to it?

If we really want serious health care reform, we need to start with changing the way we pay physicians. We need a system that provides incentives for reduced costs and quality care while protecting the eroded physician-patient relationship.

In the Senate, I’ve introduced legislation that would pave the way for meaningful physician payment reforms. The Ensuring the Future Physician Workforce Act of 2008 would get rid of the unsuccessful spending cap and focus on improving health care delivery and lowering costs. This legislation would speed up the adoption of health information technology, providing greater information accessibility, safety and savings — all while educating and empowering physicians and beneficiaries. These tools would increase the overall quality of care by boosting competition among doctors, while enabling patients to better engage their physicians and evaluate their care.

Under the current spending cap, the Centers for Medicare & Medicaid Services expect Congress to cut a certain percentage of Medicare reimbursements each year. In turn, Congress struggles to find ways to delay this cut and prevent more physicians from turning away Medicare beneficiaries.

The costs for delaying these cuts, however, are staggering. If a permanent fix is not found, every physician in Texas can expect to lose $18,000 between July 2008 and December 2009.

My bill stops the rate-cut charade and eliminates the reimbursement cap. The effect on spending is the same, but physicians are given fair reimbursements and more peace of mind. As a result, patients would also benefit from more certainty concerning the health care services they depend on.

Our health care system is in need of major reforms. This is one solid step we can take to increase both the access to, and quality of, our health care. Once we ensure a viable future generation of physicians, we can begin to work on increasing insurance coverage for Texans so that everyone has access to the world-class medical services our state has to offer.

Cornyn, a Republican, is Texas’ junior U.S. senator.

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