“Doc Fix”: The War of All Against All Begins!

The U.S. Senate passed H.R. 2, the so-called Medicare “doc fix,” 92-8 last night.  By the time you read this, President Obama will likely already have signed it. He’s eager to do so, because it locks in Obamacare’s vision of the relationship between physicians and the state.

This was a seriously flawed bill, as NCPA has discussed exhaustively (here and here). Now, doctors and patients will have to get used to a new reality where the federal government and beltway lobbyists’ priorities are more deeply embedded in physicians’ offices than ever.

Billy Wynne at the Health Affairs blog has a very good, dispassionate response to the bill’s passage. Wynne starts by describing the Merit-Based Incentive Payment System (MIPS):

The MIPS is basically a consolidation of three pay-for-performance programs already underway and the addition of another.

…the new incentive structure would be budget neutral. For every doctor that makes more from the MIPS, there will be one who makes less. A true zero sum game, if you will.

In other words, physicians will become engaged in a fratricidal war of all against all. Wynne continues:

Futurists all, Congress here would also set payments for the years 2026 and beyond. Then, the degree to which an individual doctor’s pay is increased will be dictated by their participation in so-called Advance Payment Models (APMs). Right now, that means accountable care organizations (ACOs), medical homes, bundled payment models, and the like. What that’s going to mean in 2026, I can’t say. What I can say is, god willing, I won’t be writing about it by then.

In other words, politicians with crystal balls will continue to decide how much physicians, as a profession, get paid.

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