Open Letter to Senator Isakson
Dear Senator Isakson:
Thank you for the courtesy of an explanation concerning your vote on the upcoming Medicare cut. Let me share with you some thoughts.
The 10 day “reprieve" is necessitated by Congress taking a 4th of July vacation. That vacation is being taken while gas prices are over $4.00, homes are being foreclosed and critical issues like the viability of the Medicare program are at stake.
Medicare is withholding my payments for 10 days during which time my Accounts Receivable will increase. What fee schedule should I submit with my claims during that time?
If I hold my claims for 10 days my cash flow drops. If I pay my taxes late, I get charged interest and penalties. Maybe you'll help me if I tell the IRS that I am on July 4th holiday for a week and that's why the money was late.
If your real estate commissions were held for a month while the buyer decided how much you would be paid - you and your agents would be screaming. We are screaming. Suppose the doctors decided to not see Medicare patients until Congress finished their 10 day vacation and fixed the situation. It won't happen - we feel a moral obligation to do our jobs.
The Medicare bill that generated so much last minute smoke and heat takes the money from the Medicare Advantage Programs (paid to companies like Humana, Aetna, Cigna and others) which merit a 12 percent increase (because they weren't making enough money) in the face of a proposed 11 percent cut for the providers who give the care. The President said he would veto it because it would take money away that had been promised to the insurance companies. Next time you get chest pain, call an insurance salesman.
It is time for Congress to show leadership. We have pointed out for years that the Sustainable Growth Rate (SGR) formula is flawed. Yet, nothing is done. The problem is avoided and temporary patches are applied hoping the next guy will take the heat. We have had to fight to get cuts stopped every year. Instead we get paltry increases (visit the 1 percent this year). Our staffs need to pay for gas to come to work. Georgia Power needs to be paid for our office lights. The rent goes on. In the last 5 years we have experienced 20 percent inflation in our costs of doing business. Congress holds out a 1 percent increase and expects us to lick their hands in gratitude for not having cut us 11 percent this year. I think not.
Some ideas I would like you to consider are;
1.) Abolish the SGR.
2.) Have the GAO do studies on the effectiveness of the cost control efforts of Managed Care and Medicare Advantage plans. Please explain to me why, when the power company wants to raise its rates - they have to justify it to a publicly elected commission - but - when health plans want to raise rates, they don't have to explain it to anybody? They just do it.
3.) Immediately institute the payment recommendations of RUC to CMS for primary care Medical Home services. When a recommended fee change for a surgical procedure is made, it is done that same year - why does a recommendation for the improvement of primary care services to Medicare recipients need pilot studies and bureaucratic proof before it is done?
4.) fully fund medical educational initiatives to increase the number of students and residents going into primary care (your payment program cuts and those of managed care have depleted our ranks and dried up our pipeline). We do not have the workforce in primary care right now to take care of a universal access health care program.
5.) Fix malpractice liability - the cycle is moving - we will have another crisis soon. Institute Worker's compensation policies for medical injury and product liability - institute "loser pays" into the system and cap the tort fees for lawyers and give the money to the injured.
6.) Fix Medicare Part D - We can competitively bid for bullets, bombs and battleships but not for drugs. The VA's costs for drugs are 58 percent of retail while Medicare Part D is over 90 percent of retail. Ask Medicare Part D recipients how painful it is to be in the "donut hole' which is really a "black hole" for their money.
7.) institute a national medical record where all the information on my medical records are available to every physician and hospital in the nation on line improving the documentation and communication and cutting out the $10 billion which Medicare alone spends on unnecessary duplicate testing. England is spending more that the US on a national health record with 1/3 our population. The privacy people will object but I trust the government to protect information now and the insurance companies have much of this information now and no one is crying foul.
Please let me correct one thing - you talk about "reimbursement" - this is not reimbursement. This is payment for services. It is the same type of payment that my dad earned in the coal mines. It is the same type of payment which you receive when one of your agents sells a house. It is the same type of payment I pay at the grocery store or the gas pumps. You are cutting the payment for my taking care of Georgia's elderly and disabled - you are not reimbursing me a thing.
Mr. Isakson, you were sent to Washington to lead not to obstruct. It's time to get on the offense and stop all the defensive party saving and face saving maneuvering. I recognize that you are not running this year - but you will again in the future and the pain which this dysfunctional system is causing my patients and your constituents will not be forgotten.
I am forwarding this to Senator Chambliss who voted like you did and who IS running this year. I am tearing up my campaign contribution checks today. I am going to watch who, between now and October, demonstrates real leadership not party line preservation.
That is where my support and vote will go. I'd like it to be you both. It is up to you both. You wanted the job. We gave it to you. Now do it.
George W. Shannon, M.D.
Family Physician
Columbus, Georgia
Thank you for the courtesy of an explanation concerning your vote on the upcoming Medicare cut. Let me share with you some thoughts.
The 10 day “reprieve" is necessitated by Congress taking a 4th of July vacation. That vacation is being taken while gas prices are over $4.00, homes are being foreclosed and critical issues like the viability of the Medicare program are at stake.
Medicare is withholding my payments for 10 days during which time my Accounts Receivable will increase. What fee schedule should I submit with my claims during that time?
If I hold my claims for 10 days my cash flow drops. If I pay my taxes late, I get charged interest and penalties. Maybe you'll help me if I tell the IRS that I am on July 4th holiday for a week and that's why the money was late.
If your real estate commissions were held for a month while the buyer decided how much you would be paid - you and your agents would be screaming. We are screaming. Suppose the doctors decided to not see Medicare patients until Congress finished their 10 day vacation and fixed the situation. It won't happen - we feel a moral obligation to do our jobs.
The Medicare bill that generated so much last minute smoke and heat takes the money from the Medicare Advantage Programs (paid to companies like Humana, Aetna, Cigna and others) which merit a 12 percent increase (because they weren't making enough money) in the face of a proposed 11 percent cut for the providers who give the care. The President said he would veto it because it would take money away that had been promised to the insurance companies. Next time you get chest pain, call an insurance salesman.
It is time for Congress to show leadership. We have pointed out for years that the Sustainable Growth Rate (SGR) formula is flawed. Yet, nothing is done. The problem is avoided and temporary patches are applied hoping the next guy will take the heat. We have had to fight to get cuts stopped every year. Instead we get paltry increases (visit the 1 percent this year). Our staffs need to pay for gas to come to work. Georgia Power needs to be paid for our office lights. The rent goes on. In the last 5 years we have experienced 20 percent inflation in our costs of doing business. Congress holds out a 1 percent increase and expects us to lick their hands in gratitude for not having cut us 11 percent this year. I think not.
Some ideas I would like you to consider are;
1.) Abolish the SGR.
2.) Have the GAO do studies on the effectiveness of the cost control efforts of Managed Care and Medicare Advantage plans. Please explain to me why, when the power company wants to raise its rates - they have to justify it to a publicly elected commission - but - when health plans want to raise rates, they don't have to explain it to anybody? They just do it.
3.) Immediately institute the payment recommendations of RUC to CMS for primary care Medical Home services. When a recommended fee change for a surgical procedure is made, it is done that same year - why does a recommendation for the improvement of primary care services to Medicare recipients need pilot studies and bureaucratic proof before it is done?
4.) fully fund medical educational initiatives to increase the number of students and residents going into primary care (your payment program cuts and those of managed care have depleted our ranks and dried up our pipeline). We do not have the workforce in primary care right now to take care of a universal access health care program.
5.) Fix malpractice liability - the cycle is moving - we will have another crisis soon. Institute Worker's compensation policies for medical injury and product liability - institute "loser pays" into the system and cap the tort fees for lawyers and give the money to the injured.
6.) Fix Medicare Part D - We can competitively bid for bullets, bombs and battleships but not for drugs. The VA's costs for drugs are 58 percent of retail while Medicare Part D is over 90 percent of retail. Ask Medicare Part D recipients how painful it is to be in the "donut hole' which is really a "black hole" for their money.
7.) institute a national medical record where all the information on my medical records are available to every physician and hospital in the nation on line improving the documentation and communication and cutting out the $10 billion which Medicare alone spends on unnecessary duplicate testing. England is spending more that the US on a national health record with 1/3 our population. The privacy people will object but I trust the government to protect information now and the insurance companies have much of this information now and no one is crying foul.
Please let me correct one thing - you talk about "reimbursement" - this is not reimbursement. This is payment for services. It is the same type of payment that my dad earned in the coal mines. It is the same type of payment which you receive when one of your agents sells a house. It is the same type of payment I pay at the grocery store or the gas pumps. You are cutting the payment for my taking care of Georgia's elderly and disabled - you are not reimbursing me a thing.
Mr. Isakson, you were sent to Washington to lead not to obstruct. It's time to get on the offense and stop all the defensive party saving and face saving maneuvering. I recognize that you are not running this year - but you will again in the future and the pain which this dysfunctional system is causing my patients and your constituents will not be forgotten.
I am forwarding this to Senator Chambliss who voted like you did and who IS running this year. I am tearing up my campaign contribution checks today. I am going to watch who, between now and October, demonstrates real leadership not party line preservation.
That is where my support and vote will go. I'd like it to be you both. It is up to you both. You wanted the job. We gave it to you. Now do it.
George W. Shannon, M.D.
Family Physician
Columbus, Georgia
posted by George W. Shannon, MD at
4:24 AM
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