Or not.

Hospital doctors who quit their jobs are being routinely forced to sign “gagging orders” despite legislation designed to protect NHS whistleblowers, it is revealed today.

Millions of pounds of taxpayers’ money are being spent on contracts that deter doctors from speaking out about incompetence and mistakes in patient care.

via Millions spent on doctor ‘gagging orders’ by NHS, investigation finds – Health News, Health & Families – The Independent.

Wow.

I’m not being snarky here, I really have no idea: does this happen in the US?

It surprises me more than you.

This (the 21% SGR cut (backgrounder)) is typically just the match to get my fuse lit.  And now that I’m facing a 21% pay gut from my single biggest payor, I’m not really angry about it.

Wary of the change to my income, which will be some but not a huge amount (I hope); weary of the political machinations of a few smart, well intentioned elected representatives on both sides of the aisle and the legion of mouth breathers that fill the rest of the chamber.

It’s been SGR pong for about 10 months now, with patches, band-aids, clever financing and a lot of we’ll kick that can a bit more.  I was energized against the cuts back when they were happening several band-aids ago (and this game of congressional chicken has been going on for a decade at least), and I think I’ve finally reached an emotional exhaustion point.  Frankly, I’m glad it’s happened.  (That girlfriend who kept threatening to leave finally did, and you feel sad but actually liberated, as the BS finally stops).

I sincerely hope this cut stays in place for several more months, maybe a year.  It’ll be instructive to a lot of us, one way or another, on whether a massive and massively underfunded entitlement program can be effectively overhauled, or whether we’re doomed financially.  Greece without a bailout, unless it’s in Yuan.

I hope every provider out there who doesn’t have to take Medicare drops it. Yes, they’ll see Grandma, but bring your checkbook.  (If enough dropped their Medicare, congress would have to include a re-sign-up amnesty rather than enforce the 2 year restriction on re-signing, lest the fix have no one to practice it).  And if Medicare isn’t fixed, well, they lost nothing.

(Some medical economist out there has to know this: at what point would shedding the myriad rules (and attendant paperwork, and administration, i.e. overhead) pay for itself in just opting out, as a hospital or system?  If nothing else that would make pricing for hospital-based care very price transparent, and competitive.  I wonder how many people in the carpeted zone exist only to serve the unfunded governmental mandates?  I’d be willing to be nobody knows, as it’s such a crazy idea, and it’s an industry that’s just beaten down with so many rules, and mandates.

So, I have no real fight on this topic left.  It’s abundantly clear neither party wants to fix this, which is more than depressing.

Also, a full apology to MovinMeat over at allbleedingstops.  I took him to task in the comments to this post for being a Single Payor advocate, forgetting that he’s not been one, ever so far as I can recall.  I got that part wrong.  (The rest stands).

However, those who’ve been advocating a Single Payor system, imagine the fun of doing this kick the can routine, brinkmanship, etc, for all the health-care in the US.  Continually, like we’re doing now with a small part they cannot either fix or control, SGR.

So, see?  Not ranting.

Update: While I was writing this:

June 24, 2010 — After another week of tough political wrangling and more twists and turns than a roller coaster, a 6-month “doc fix” that rescinds a 21.3% cut in Medicare reimbursement to physicians passed the House of Representatives tonight, 417-1.

The bill, which is retroactive to June 1 and also provides a 2.2% rate increase, was passed by the Senate on June 18 and will now be sent to President Barack Obama for his signature.

Critics Question Study Cited in Health Debate

By REED ABELSON and GARDINER HARRIS

In selling the health care overhaul to Congress, the Obama administration cited a once obscure research group at Dartmouth College to claim that it could not only cut billions in wasteful health care spending but make people healthier by doing so.
…

But while the research compiled in the Dartmouth Atlas of Health Care has been widely interpreted as showing the country’s best and worst care, the Dartmouth researchers themselves acknowledged in interviews that in fact it mainly shows the varying costs of care in the government’s Medicare program. Measures of the quality of care are not part of the formula.

via Data Used to Justify Health Savings Effort Is Sometimes Shaky – NYTimes.com.

Really, it’s like the decided what they wanted, then went and found data to back that up.  Bad data, sure, but it says what we want!

Support for repeal of the new national health care plan has jumped to its highest level ever. A new Rasmussen Reports national telephone survey finds that 63% of U.S. voters now favor repeal of the plan passed by congressional Democrats and signed into law by President Obama in March.

Prior to today, weekly polling had shown support for repeal ranging from 54% to 58%.

Currently, just 32% oppose repeal.

via Health Care Law – Rasmussen Reports™.

I think a lot of this could have been avoided, mostly by allowing the bill to be read, understood and tweaked, prior to voting.

We’ll see.

The Pentagon’s brownie recipe is 26 pages long.

via How to Make Brownies, Pentagon-Style – Hit & Run : Reason Magazine.

Yes, more government in healthcare is Just the Trick.

April 15, 2010 — Physicians once again have dodged a financial bullet. The Senate today voted 59 to 38 to delay a 21.2% Medicare pay cut from April 1 to June 1 — the third such delay this year.The postponement of the massive reduction in Medicare reimbursement was part of a larger bill that extends expired unemployment compensation benefits and subsidies for health insurance premiums for out-of-work Americans under the COBRA program.

via Senate Delays Medicare Pay Cut to June 1.

I’m absolutely certain that by June 1st there will be a seriously well thought out solution to this. /snark.

Awesome! I wanted a pay cut, now I get it!

April 14, 2010 — Senate Democrats are still trying to postpone a 21.2% Medicare pay cut for physicians from April 1 to either May 1 or June 1, and they may get the job done by week’s end.

However, they have missed a deadline of sorts that may temporarily complicate physicians getting reimbursed by Medicare.

The pay cut technically took effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) tried to spare physicians the consequences by instructing carriers to hold payment on claims for services rendered in April for the first 10 business days of the month — that is, through today. The hope was that Congress would postpone the pay cut before tomorrow, April 15, which would allow carriers to reimburse suspended physician claims at the old rate.

via Senate Misses Deadline for Delaying Medicare Pay Cut.

For the record, I want a fix to the SGR. And, as a practical matter this doesn’t change my practice as a hospital based doc.  It will affect my bottom line, and we’ll see how that shakes out.

This doesn’t bode well for us as physicians.  Since we’ve allowed ourselves to become dependent on / beholden to the feds for third party reimbursement, this perpetual game of chicken was bound to come to an end.  And, it has, though not how anyone would plan, or foresee.

(For those who like fables, we’ve had the croc ride, and now we’re to be eaten).

There’s a significantly cautionary tale in this for the current healthcare legislation, which has been described to me, by a PhD Economist who’s read it (and had some hand in it) as being an Insurance Regulation bill, which aims to have docs be the ones who are responsible for healthcare rationing.  It doesn’t work.

SGR was meant to have docs put some skin in the game of medicare expenditures, i.e., when costs exceed the SGR, docs get a pay cut.  Had that cut happened at 1%, maybe it would have had a positive effect (choose your own positive), and perhaps not.  Make it a 21% cut, and the effect is likely to be pronounced.  And negative, in the common parlance.

So, brave new world and all that.  I’d like to say I can make it up in volume, but we’re already crammed to the gills in ED’s all over, so I don’t know how this will work out.

Get.  Out.

Educating individuals about the costs of healthcare could save money and lead to a more efficient use of the healthcare system, report policy researchers at Tufts University School of Medicine and Boston University School of Public Health

via Educate The Public To Prevent Sky-Rocketing Health Care Costs | The Behavioral Medicine Report.

You mean, people, when faced with facts about cost (and their end of it) choose the less costly option?  When did this start?

Oh yeah, we do it all the time, except in medicine.  Where our costs will bankrupt the country.

Hey, what’s actually in the Health Care bill?  This is from the ranking Republican member of the House Ways and Means committee:

To see how the next few years will go, click here.

via There’s Aging Gracefully, Then There is This… A Timeline of the Democrats’ Health Care Bill | House Committee on Ways & Means – Republican.

Knowledge is power.  Time is money.

This is just a very quick off the cuff, personal assessment, from many miles away from Capitol Hill, of what ACEP can learn from the health reform process we have just gone through.

via What ACEP Can Learn from the Federal Health Reform Process « The Central Line.

So, essentially we were represented, nobody listened, and the answer is to spend more money on the same arrangement to hope for a different outcome?

Color me skeptical.