Medicare Meaning Lean

Medicare Cuts for Hospitals May Mean Lean Times for EPs | ACEP | 3.06

Proposed cuts to Medicare’s Part A programs “would have a significant financial impact on emergency physicians,” said Dr. David C. Seaberg, a member of the board of directors with the American College of Emergency Physicians.

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Medicare Part A payment reductions would affect the hospital update at market basket over this time period, as well as the payment updates for skilled nursing facilities, home health, hospice care, and inpatient rehabilitation.

Most emergency physicians are not hospital employees–they either belong to an independent group or a faculty plan. These groups would be affected…

The cuts would directly affect the reimbursement situation in emergency departments, because “roughly 25% of the patients most emergency departments care for are Medicare patients,” Dr. Seaberg said.

With hospitals taking a direct financial hit, the trickle-down effect would be a decrease in emergency physicians’ Medicare payments…”[s]ince most third-party payers base their rates on Medicare rates, perhaps all payers would lower their rates as well,”…

A more indirect effect of the cut would be that “we have physicians out in the community who no longer want to take Medicare patients,” he said. “So where are these patients going to go: [these] older patients with significant comorbid diseases, who are sicker than the average patient? They’re going to go to the ER,”…

I must have read this piece three or four times—and finally gave up trying to make sense of it. I concluded that this was just another fluff piece pandering to the overall fear and misunderstanding of the Medicare program.

From “The Official U.S. Government Site for People with Medicare“:

What does “affect the hospital update at market basket” mean? Is this the economic usage of market basket as a surrogate marker for the market performance? If so, the sentence, in total, makes no logical since.

The article gives us three options on the affect of Medicare A reductions upon emergency physicians:

• Direct Effect
• Trickle-Down Effect
• Indirect Effect

Two final points of nonsense are:

1. The linkage of Medicare Part A reductions with community physicians and their willingness to see patients. Sorry, but the physicians in the community, regardless of their willingness, are not affected by Medicare Part A—that’s Medicare Part B.
2. What exactly is the linkage between a third-party payer’s rates based upon Medicare Part A and the rates based upon Medicare Part B—separate and distinct programs and funding mechanisms. There is no way to link hospital reimbursement under Part A with physician reimbursement under Part B.

Is there an affect of Medicare Part A reductions on the setting in which emergency physicians practice? Absolutely, and it is inseparately linked to the fiscal well-being of the hospital—and that’s the real lean and mean about Medicare Part A reductions.