Crystal Ball Gazing 2013

  • Hertzberg, Linda, MD, FASA
| Jan 07, 2013

The holidays and new year have come and gone, and it is back to work today after some time off with the family. I also spent some time, as I suspect many of you did as well, reading and thinking about the “fiscal cliff” issues and becoming disheartened that there did not seem to be much will, or good will, to get something meaningful done by the end of the year.

The tax implications of the final fiscal cliff package were heavily covered by the national press. Noted only in passing was the fact that the “doc fix” was included, delaying yet again the reduction in Medicare fee schedule to physicians mandated by flawed the SGR formula, as well as the scheduled 2% rate reduction. In the spirit of robbing Peter to pay Paul, some of this came on the back of hospital payments over a number of years.

This is discussed in an piece, “‘Doc Fix’ Extended Through 2013,” in which representatives of both the AMA and AHA expressed dissatisfaction with the current situation and called for a long-term solution to the ongoing issue.

In an article in the Washington Business Journal, “Medicare ‘doc fix’ problem only getting worse,” reporter Ben Fischer writes that there was “no apparent effort to solve the underlying problem.” His summary of the situation follows: “And now, with this latest solution, the money is coming from other health care programs, so expect industry infighting the next time it comes up. Without an extremely unlikely grand bipartisan solution in the next 12 months, get ready for Hospitals vs. Doctors this time next year.” In “The Fix that Failed,” Westby G. Fisher, MD discusses this in slightly more colorful terms. I recommend reading all three pieces for a more complete understanding of the problem and how it will reflect back on physicians next year, if a long-term solution is not created.

If this is not enough doom and gloom, consider this article from the New York Times this weekend, “Health Insurers Raise Some Rates by Double Digits.” The first three paragraphs summarize the issue well:

“Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.     

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.”

It would appear that it is business as usual for insurers. Whether patients will receive better benefits and coverage is open for discussion. In the meantime, at least on the local level here in Fresno, some of these same insurers are negotiating to drive down the rates of physician compensation for services.

Leadership at the ASA is thinking about ways to create new payment models in anesthesia practice and help guide the discussion on the national level as those of us in the trenches attempt to adapt new models of practice during the era of the ACA. One model being discussed and refined by the ASA level is the Perioperative Surgical Home™. In this model, anesthesiologists would be responsible for coordinating care of the patients in all aspects of the perioperative period, thereby gaining the advantages of efficiencies of standardization of evidence based care, decrease variation in utilization and expenditure, and the measurement of quality outcomes. Physicians would be paid a rate, adjusted to the intensity of care and complexity of each case, for coordinating the care of a patient. Although the concept appears sound, it seems that the devil is in the details. What remains to be determined is how anesthesiologists. who are accustomed to the traditional model of anesthesia practice, will embrace the concept. Payment models are still being created for the Perioperative Surgical Home™, and whether physicians and insurers will adapt to and adopt these models remains an open question.

This is enough of my depressive crystal ball gazing for the upcoming year. In 2013, I recommend that everyone resolve to stay up to date, informed on the issues, politically active and proactive in your choices in your own practice. If you are not attending the CSA Winter Anesthesia Seminar in Hawaii later this month, or the CSA Spring Anesthesia Seminar in California in April, I recommend you consider going to the ASA Practice Management Conference in Las Vegas to learn more about the issues and controlling your own destiny in these uncertain times.

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