The revisions to the Senate health system legislation that led to the American Medical Association’s support did little to sway the opposition of the Louisiana State Medical Society.

 

Ditto for the $300 million “fix” for the federal medical assistance percentage, or FMAP, Sen. Mary Landrieu, D-La., negotiated in exchange for her vote.

 

Although the latter was important, Dr. Patrick Breaux, medical society president-elect, said the total bill still puts the state at a severe economic disadvantage.

 

Expanding the eligibility for Medicaid will cost Louisiana $130 million a year, Breaux said. Louisiana also faces the loss of around $400 million a year in funding for public hospitals through cuts in Medicaid’s Disproportionate Share Hospital funding, which hospitals receive for treating larger numbers of low-income patients.

 

“We’re looking at (losing) over $500 million a year,” Breaux said, “so $300 million doesn’t quite make up for that loss.”

 

Add in Louisiana’s severe budget crunch and a state constitution that limits the state’s budget options mainly to cutting spending on higher education and healthcare, Breaux said. The result is that physicians and other providers will see drastically lower Medicaid reimbursements.

 

“That’s going to inevitably impact the access of patients to healthcare,” Breaux said. “Doctors and hospitals, as far as that goes, cannot continue to provide services at well below their costs.”

 

Medicaid reimbursements are around 60 percent of Medicare payments, which themselves cover only around 90 percent of the actual cost of providing care, Breaux said.

 

The Medicare program also faces $500 billion in cuts under the Senate bill, and because 80 percent of those expenditures go to providers, physicians and hospitals will see even more cuts to reimbursements, Breaux said. Since Medicare payments don’t cover the cost of care now, even more costs will be shifted to private insurers and then to employers, workers and consumers.

 

Supporters say the bill would result in 31 million more Americans getting health insurance, allowing consumers to get the same coverage regardless of their health. By 2019, 94 percent of U.S. citizens and legal residents below Medicare age would have health insurance, compared to 83 percent today. They say the bill contains measures to improve patient safety, reduce medical errors and increase the quality of care. The bill is also projected to reduce deficits by $132 billion over the next decade.

 

Breaux said the State Medical Society has championed universal health coverage for years, but the group recommends that the coverage should come through private insurers.

 

Breaux said the AMA did get some changes to the bill that help physicians.

 

For instance, the bill no longer includes a plan to fund primary care and general surgery by cutting Medicare pay to specialists. A 5 percent fee on elective cosmetic surgery was dropped, as was a Medicare enrollment fee.

 

But Breaux described those moves as “small bones” thrown to physicians.

 

Other major issues remain, chief among them the establishment of an independent Medicare advisory board or commission, Breaux said. The government-selected panel would be able to write new rules governing medical devices, prescription drugs and spending targets while remaining exempt from judicial review.

 

“Anyone who disagrees with (the board’s) proclamations will have no place in the courts to appeal those decisions,” Breaux said.

 

If the advisory board remains, the AMA has asked that revisions be made to more fairly spread out the Medicare cuts, allow for legitimate spending increases and make sure the board is accountable for its actions and those actions be transparent.

 

Meanwhile, one of the AMA’s major goals, a permanent fix for the sustainable growth rate for Medicare, has not materialized, Breaux said.

 

The payment system, which helps determine physician pay, is broken and has been for years, he added. Each year, Congress postpones the scheduled pay cuts but keeps the underlying formula.

 

The AMA got only a two-month deferral of the 21 percent cut in Medicare payments to physicians; the cut is now set to go into effect at the end of this month (February), Breaux said.

 

Breaux said the State Medical Society also worries that the bill provides large multi-specialty practices… so-called integrated healthcare systems … with substantial incentives unavailable to solo or small physician practices.

 

At the same time, there are mandates for technology, such as e-prescribing and electronic medical records, which small practices can ill afford, he said.