Penalizing Those Who Serve The Most Vulnerable

The Baucus/Obama health care bill will financially penalize physicians who provide care for the sickest patients. A provision in the bill punishes doctors whose treatment plans put them in the top 10% of national annual Medicare costs per patient.

This means that all doctors treating older people will constantly be driven to try to order the least-expensive tests and treatments for fear they will be caught in that top 10 percent. Note that this feature operates independently of any considerations of quality, efficiency or waste. If you authorize enough treatment for your patients, however necessary and appropriate it may be, you are in danger of being one of the 1 in 10 doctors who will be penalized each year.

This will pressure doctors to avoid taking responsibility for the oldest and sickest (i.e., most vulnerable) patients. And every year, the pressure could intensify as a brutal cycle is set in motion:

There will always be top a 10 percent, no matter how far down the total amount of money spent on Medicare is driven. Say that in 2015, the top 10 percent is anything over $10,000 per patient. In 2016, most doctors will scramble to hold down the treatments they authorize to avoid breaking that limit.

But the real possibility, as a result, is that the total annual amount of that limit will drop. So next year, doctors will try to avoid being in the penalty box for anything they authorize over $9,500.

As tough as this will be for physicians, patients will be the real losers.

As the doctors struggle with the continually falling limit of the money they can authorize for their contingent of patients, consider what those patients will lose in the quality of their treatment.

This is what happens when politicians design health care systems.

h/t: Green Room