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This site is the inspiration of a former reporter/photographer for one of New England's largest daily newspapers and for various magazines. The intent is to direct readers to interesting political articles, and we urge you to visit the source sites. Any comments may be noted on site or directed to KarisChaf at gmail.

Thursday, December 12, 2013

This 'Doc Fix' Would Be Bad for Your Health -- By Scott Gottlieb, The Wall Street Journal

An attempt to alter Medicare may let Washington dictate how doctors treat patients. 

Imagine if a provision in ObamaCare allowed Health and Human Services Secretary Kathleen Sebeliusto dictate directly to doctors which services they could and could not provide their patients—what individual tests they could conduct, which treatments they could offer, and medicines they could prescribe.

Americans would be outraged.

Yet some Republicans on Capitol Hill are about to help Democrats pass such a provision for Medicare patients. The Senate Finance Committee is set to vote on permanent "doc-fix" legislation Thursday that grants the federal government broad new authority to determine "applicable appropriate use criteria" for the full range of outpatient medical services delivered to seniors. Similar legislative language is included in bipartisan draft legislation that is being marked up Thursday in the HouseWays and Means Committee. 

The bill is part of a larger effort to change the way Medicare pays doctors. Each year since 2002, Congress has passed temporary "doc-fix" legislation to cover billions of dollars of shortfalls in Medicare payments. The provisions in the bill apply to advanced radiology imaging tools like CT scans and MRIs. But language tucked into the legislation enables "the Secretary" of HHS to exert the same controls over the vast array of outpatient medical care for seniors.

Radiologists (and other medical specialists) struck a bargain with legislators to give them input into the development of these criteria—one reason doctor groups have rolled over. They see it as a better alternative to price cuts, or more direct controls over their medical practice. The bill does have language to give these groups a say over the criteria, but a fair reading of the bill shows these are weak and gives enormous discretion to the Centers for Medicare and Medicaid Services and "the Secretary" of Health and Human Services.

The criteria will be loaded onto a website (hopefully not HealthCare.gov) that's used to evaluate how and when doctors order the full range of outpatient tests and treatments. Doctors would have to consult the website before they order a test, and get a printout that says whether their use of the medical service conforms to the "appropriate use criteria." Doctors must submit the printout with their insurance claim to Medicare.
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