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Thursday, April 22, 2010

My Take on Medicare and Health Care Reform

I've been holding off writing on health care reform. Clearly something needed to be done. Its impossible for a practising physician not to have noticed just how wrong the current system was. Many patients did not have health insurance at all. Some who did, did not have enough to cover expensive therapies. Some had ridiculously high dedectables. Some were dropped by their insurance when they got sick. Many times, I had to spend a great deal of time on the phone with health insurance medical directors to try and get pre-approval for a necessary medication/test/procedure. Something definitely needed to change.
Now as a young Cardiologist, with a mortgage and three young girls, these are nervous times. Cardiology has been hit specifically hard by Medicare in 2010. As a way to try and save money, Medicare has changed its fee scheduled which has resulted in an overall payment cut of 11% for cardiology. Echo Payments Cut by 42%, Caths by 24%, and ECGs by 21%. Stress testing has taken a big hit too.
This will be in addition to the proposed possible 21% cut in medicare re-imbursements across the board - unless Congress permantly votes to change the dependance of the Medicare fee schedule on the flawed Sustained Growth Rate (SGR).
Now, I'm all in favor of trying to cut costs. But Cardiology is one of the only areas in modern medicine where medical breakthroughs (risk assessment, medications, testing and procedures) have dramatically reduced mortality and morbidity.
I'm also worried that the new reforms will not change the biggest issues that drive up the costs of modern medicine - fear of medical malpractice and very poor preventitive care (a real lack of focus on healthy living). If we could just prevent disease in the first place (healthy eating, frequent exercise, significant societal weight loss and frequent primary preventitive care) and keep doctors from ordering unnecessary tests out of fear of lawsuits -- we could save the entire medical community a real significant amount of $$$$$$.

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