Congress is considering changing the way it pays doctors for caring for Medicare patients - hoping it will change the way doctors "care" for them.
Studies have shown that doctors spend, on average, less than 11 minutes a visit with their patients. And elderly patients complain that doctors are not taking time to tell patients what they discover or even how to take prescribed medicine. "Take as directed" may not mean much to a patient who received no directions.According to a recent Harvard study, doctors receive significantly more for tests and operations than justified by the effort, time, stress, and overhead they expend on them. At the same time, the study showed that doctors were relatively under-paid for taking a medical history, examining, and counseling patients.
The proposed legislation would change the fee schedule paid by Medicare, increasing the payment for an office visit by 26 percent - from about $23 to $29 dollars. Surgical fees, in turn, would drop by up to 31 percent.
Critics of the current fee schedule say that it has encouraged some doctors to order unnecessary treatment, because that's where the best compensation is to be had.
The new system was recommended in mid-March by the Physician Payment Review Commission, which estimated that nearly one-third of the services ordered for Medicare patients are unnecessary or just plain wrong.
Because doctors tend to make less money from a Medicare patient than what they can charge other patients for the same service, there is some concern that doctors might decide not to accept Medicare patients.
Officials who administer Utah's Medicare program say they haven't had time to look at the proposal or form an opinion yet. "But we do have some doctors who feel already they might be better off to drop Medicare patients," one administrator said. "I just hope Congress makes haste slowly."
The legislation could be valuable if it actually increases the amount of time and care a physician spends with elderly patients and cuts down unnecessary procedures and tests.
If, on the other hand, physicians don't allocate more time but just accept the additional money, the goal of the bill would not be accomplished. And unscrupulous physicians might order more tests and surgeries than before to make up the lost revenue.
Most physicians are truly concerned with healing - and perhaps a new fee schedule would be more equitable. But before Congress proceeds it should make sure the new plan won't backfire just because a relatively few members of the medical profession would misuse it. As it is now, much more spadework must be done before an intelligent decision can be made.