Few sure things for doctors in health care reform plan

For physicians, Scott P. Brown’s surprise election to the U.S. Senate on Jan. 19 was a reminder: You can’t count on anything in health care.

“I think overall, health care reform is in a really dicey position right now,” said Kevin Pho, a Nashua, N.H., primary care physician who blogs about health care policy at KevinMD.com. “The components of it are changing on a daily basis.”

After the Massachusetts Republican barnstormed into the late Edward M. Kennedy’s Senate seat and destroyed the Democrats’ bulletproof 60-vote supermajority, the political winds behind two painstakingly crafted health care reform bills died. Thousands of pages of policy that medical professionals had been combing through to see their future were suddenly obsolete.

Whether Congress will salvage the remains of the bills that passed in November and December of last year is unclear.

But doctors and lawyers agree that some reforms are more likely to pass than others, and that the medical community should brace itself for several key changes in the coming year.

Here are a few things to prepare for:

More cuts in Medicare reimbursements

Any legislation that tackles health reform will likely reduce Medicare payments for some doctors, said Maria D. Buckley, an attorney in the Health Care and Life Sciences practice groups at Nutter, McClennen & Fish in Boston.

In fact, she noted, Medicare has already started to cut some payments routinely expected by specialists this year, in a regulatory change that did not require the blessing of Congress.

“Some changes [that] went into effect on Jan. 1 [say that] specialists can’t charge for a certain level of consultation, and other commercial payers have jumped on it,” Buckley said. “Some of the doctors were caught unaware.”

The change involves Medi-care’s reimbursements for “consultation codes,” which doctors use to bill Medicare when they confer with other physicians on a patient’s care. Since January, Medicare no longer reimburses doctors when they bill with consultation codes.

That, said Pho, who is a primary care physician, means that “specialists are feeling a little bit of a downward pressure on reimbursements.”

“[Medicare is] trying to focus more on primary care doctors,” he said. “That trend is going to continue … If you want to control costs, eventually some services are going to have to be cut.”

Buckley said that some doctors are preparing for more cuts by researching how to survive without Medicare.

“A lot of doctors are thinking about whether they want to close their practices to Medicare,” she said.

Administrative simplification

Experts also expect that whatever form reform takes, efforts to streamline recordkeeping will be involved.

“Administrative simplification deals with the enormous overhead of many insurance companies and the overhead they force physicians to have,” said Mario E. Motta, a Salem cardiologist who is president of the Massachusetts Medical Society. “Why does every insurance company need a unique form when [they all require] the exact same information? Who does that benefit?”

He said that the reform bill passed by the U.S. House of Representatives in November contained many measures mandating simplification, but that the Senate bill, which passed on Christmas Eve, did not. Still, Motta expects that paperwork fixes will prove attractive as compromise measures in the future.

Buckley, who served as senior counsel for Blue Cross Blue Shield of Massachusetts before moving to Nutter, said that physicians should expect an increased emphasis on using electronic records.

“Clearly everyone is going to have to use electronic medical records,” she said. “For doctors who haven’t done that, the incentives and the pressures to do that will increase.”

Tort reform

Now that the Democrats are being forced to parley with Republicans, Motta expects that the prospect of medical malpractice reform is back on the table.

Tort reform measures were limited to small state-level pilot projects in last year’s health reform bills, he said, because the Democrats have historically been opposed to such measures.

“Up until last year, the Democrats didn’t even want to admit that liability was an issue,” he said.

Now that the two parties must find common ground, Motta thinks that tort reform will be one of the first compromises to be made.

“Clearly, this is one of the lowest hanging fruits there is,” he said. “The Republicans have said all along that if you want to get them on board, you must consider meaningful tort reform.”

MMS isn’t waiting for Congress to act, however. It is sponsoring a bill in the Massachusetts House of Representatives that would give doctors and patients a chance to uncover medical errors and reach settlements before any legal claims have been filed. The so-called ‘Apology bill” – formally known as “An Act Improving Patients’ Access to Timely Compensation” – is currently being considered by the Joint Committee on the Judiciary.

“If that [bill] passes, that will completely change the landscape” in Massachusetts, Motta said.

On a federal level, however, Pho isn’t as confident as Motta that medical liability measures will be a large part of any health care package.

“I wouldn’t hold my breath,” Pho said.

He pointed out that despite the new bipartisan veneer in Washington, it is likely that the Democrats will push forward with health care reform without meaningful input from Republicans.

“I think that the Republicans don’t have a lot of influence right now,” he said.

But Pho conceded that if Republicans do manage to shape a new bill, med-mal reform “might be a part of it.” MMLR

Questions or comments may be directed to the writer at:

julia.reischel@lawyersweekly.com