Is it worth it to keep a comatose patient on life support for five years, hoping that medical science might develop a miracle cure?
Alternatively, is it worth it to defer Medicare reimbursement cuts for five years, hoping that Congress might pass a permanent fix to the Sustainable Growth Rate formula?
Members of Congress have floated for months the possibility of a five-year fix to the Medicare reimbursement system. Cuts of 21.3% take effect June 1 unless Congress applies yet another patch, a fifth temporary reprieve, to stave off the cuts. The American Medical Association objects to the five-year plan, saying it will only result in even steeper cuts when it expires. As the organization's immediate past president, Nancy H. Nielsen, MACP, pointed out in February, pushing off a permanent solution just increases the eventual price tag each time.
The Texas Medical Association points out that this current round of cuts isn't actually a 21.3% cut, it's a cumulative 83% cut since 2001. They have a reason to grieve over an ailing system. Medicare's morass is already driving the state's primary care internists and subspecialists alike to drop Medicare. This especially hurts in a state already strapped for primary care physicians.
There could be a permanent solution to Medicare reimbursement, if some political willpower could be mustered. Maybe that's what the AMA is holding out for. But right now that willpower is flagging and possibly flat-lining in the face of partisan opposition and concerns over the eventual costs of paying physicians to care for patients. Meanwhile, there's still patients to care for, not hypothetical, vegetative ones but real ones who are walking, talking and concerned about their health and their relationship with a primary care doctor. So reimbursement fixes will continue to require a hospice approach, holding out for a month at a time, or possibly getting a reprieve until the end of the year.
(The Hill, Fierce Healthcare, Texas Medical Association, Houston Chronicle, Politico)