OMA Remains Neutral on National Health Reform

March 31, 2010 – The health reform package signed into law by President Obama doesn’t pass muster with the Oregon Medical Association, which remains critical of the sweeping reform.

 

Congress went too far afield, they contend, by taking payment reform out of the political arena, and creating an independent payment advisory board, which could ultimately diminish their influence. It’s unknown who will serve on this advisory board.

 

“Whatever control we might have had slips away completely,” said Dr. Peter Bernardo, president of the Oregon Medical Association and a general surgeon in Salem. That advisory board is charged with overhauling the Medicare payment system, and, potentially, taking that authority away from Congress. “Our ability to reflect change will be limited since it’s unclear who will have the final say.”

 

The current payment system hasn’t changed significantly since 1967, and definitely needs to be brought into the 21^st century, Bernardo admitted. Primary care physician rates are too low, and less money should be spent on imaging tests and specialty care.

 

“But groups in medicine are looking at that new panel, and are worried about where the control and influence will come from,” he added. It’s no secret that Oregon physicians have been hard hit by low Medicare rates and worry that a new payment system could further compound this problem. “Physicians are horribly frustrated with Medicare reimbursement right now.” Typically commercial insurers follow Medicare’s lead when setting rates.

 

Meanwhile, many other physicians are heralding the reforms planned for Medicare. Those doctors, such as reform advocate Dr. Paul Hochfeld in Corvallis who led the Mad As Hell Doctors, have countered groups such as the OMA and the American Medical Association.

 

Hochfeld said the changes to physician reimbursement were a rare bright spot in the legislation. “Physicians are a much bigger part of the problem than most people are willing to talk about because there are lots of perverse incentives in the system,” he told The Lund Report in a previous article.

 

Before a new payment system appears on the horizon, doctors are saddled with an archaic reimbursement system begun in 1967, known as the Sustainable Growth Rate Formula. Originally it was intended to hold down Medicare spending, but only impacts physicians, not hospital services.  

 

Nearly every year physician rates have gone down. During the last go-around – 18 months ago – physicians saw a 15 percent cut. Another 21.3 percent reduction was expected on April 1. But following a flurry of lobbying activity, Congress delayed that cutback until October.

 

“We haven’t seen a raise in 10 years and would like to see that formula thrown out and some other calculation developed to determine physician fees on an annual basis,” Bernardo said. “Even a couple percent a year would be a win. We’re holding our legislative leaders to their promises.”

   

Unless the system is fixed, Bernardo worries about access problems for Medicare patients. It’s already nearly impossible for seniors in the Salem area to find a physician, he said.

 

However, it’s unlikely there’ll be a quick fix come October because most lawmakers will shy away from such a hot-button issue so close to the election, Bernardo said. “This issue is going to be a difficult distraction. I wouldn’t be surprised to see Congress give us a 1 percent increase, and punt the issue down another year.”

 

Physicians are extremely disappointed that Congress failed to enact comprehensive tort reform. “There’s significant resistance, and the trial bar is very generous with their money and has a great deal of influence as a result of their contributions,” Bernardo added. “There are far more lawyers in Senate and the House than physicians.”

 

Defensive medicine eats up between 5-10 percent of the healthcare budget. “We think 5 percent is a reasonable number,” said Bernardo, who led the 2004 campaign in Oregon to set limits on non-economic damages, a measure defeated by voters.

 

Yet Bernardo isn’t giving up. He’s agreed to serve on a new medical liability task force that’s been appointed by the Health Policy Board. To date, no meetings have been scheduled.

 

Because of these misgivings, the OMA, which represents 7,900 physicians, decided to take a neutral stance on the reform package.  

“The house of medicine is divided on this bill,” Bernardo said. “We have physicians on both sides of the fence. We didn’t feel as a representative organization that we could split the difference and be supportive.”

 

But there could be trouble ahead for the American Medical Association, a huge supporter of the reform. Ultimately it could lose half of its 250,000 members in June because so many physicians disagree with the final version.  

 

“The AMA has taken a tremendous amount of heat over this,” Bernardo said. “If the AMA loses leverage, physicians as a whole will suffer, and their voices and influence will be diluted.” 

 

TO LEARN MORE