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A Cut to the Jugular for Primary Care Docs.

It is all transpiring under the radar. No one seems to care. Few are fighting it, even fewer are reporting on it. And yet the implications of what Congress is poised to do will have profound reprucussions for doctors, patients, and the entire Medicare system. See a new article in Kaiser Health news in which I am interviewed: CLICK HERE for the article.

When the Affordable Care Act (ACA) passed 6 years ago, one of its goals was to increase the number of primary care physicians. Multiple studies have demonstrated the value of primary care in providing quality and cost effective care; in areas of the country with more primary care doctors, patients do better at a lower cost. Without a doubt we need more primary care doctors. As I discuss in my book, primary care is a dying field. Few medical students go into it, while those practicing it are rapidly fleeing. Some are retiring, some are becoming concierge, many others are curtailing their Medicare patient population. Unfortunately, much of what the ACA and Medicare has imposed on us as "reform" has only exacerbated primary care stress, pushing even more people out. With one notable exception. The ACA did provide primary care doctors with a 10% bonus payment. This has allowed us to keep up with the increasing demands imposed on us from reformers, while giving us a much needed slap on the back for taking care of complicated Medicare patients. It is no surprise that one of the most salient (and fixable) barriers to students entering primary care is the huge salarly gap between primary care docs and specialists. The 10% bonus was a baby step in the right direction to narrowing that gap.

But starting January 1st 2016 that bonus will simply disappear due to Congressional inertia and CMS shortsightedness. In effect, primary care doctors will be hit with a 10% pay cut for all of our Medicare patients. For geriatric practices like mine, the cut will be very impactful; we expect a nearly $20,000 drop in salary for each of our group's providers. Rather then incenting more people to enter primary care, and more primary care doctors to accept Medicare patients, this cut will accomplish just the opposite. Many practices will feel the sting of the pay cut much less, as they see only a small number of Medicare patients. But one fact is certain: no doctor will be opening his/her door to Medicare, especially when better options are available.

As Medicare imposes multiple restrictions, rules, and pay cuts on primary care doctors, private insurers like Blue Cross are incenting doctors who see non-Medicare patients. Our practice, with 85% of our patients being elderly, does not qualify for other insurance company's incentives. We are told that we have to wait for our Accountable Care Organization (ACO) to be sufficiently profitable to give us a small bonus (something accomplished rarely, as we have discussed), while we lean on Medicare's complicated chronic care management programs to buy us a few more dollars. Most primary care doctors in my universe are moving away from Medicare, an exodus this cut will clearly exacerbate. Shouldn't we be doing just the opposite of what Congress is about to execute? Shouldn't we be paying primary care doctors more to care for Medicare patients, encouraging more students to enter primary care, and leveling the playing field a bit? Let's hope that Congress wakes up once the ramifications of their inaction become more clear!

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