Although I am usually too cynical to engage policymakers, I took the time to draft a letter:
Dear ____,
I am a board-certified pain physician who opened my own medical practice earlier this year in _____, seeking to fulfill a lifelong dream of serving an under-recognized and suffering patient population. It has been a long journey: 4 years of college, 4 years of medical school, 4 years of residency, and a year of fellowship. It was not easy. I used to work two full-time jobs, with nights spent on-call as a volunteer at a crisis hotline office because I could not afford rent, so that I could save enough money to afford the expensive medical school application process. Yet I graduated from medical school with over $250,000 in student debt. Working 80 hours/week as a resident and fellow for 5 years, half of my after-tax income was spent on student loan payments.
This August, after finally completing the training process, I opened _____, a medical office dedicated to the comprehensive treatment of chronic pain. It has been a tiring but rewarding process. I am able to offer my patients a range of advanced pain therapies, including epidural injections and spinal cord stimulation, which spare my patients the pain of intensive surgeries and the medical risks associated with long-term narcotic medication use. As an independent clinician, I am able to spend as much time with my patients as needed, free from administrators that force doctors in hospital-owned facilities to see X patients per hour, regardless of their patients' individual needs. Unnecessary spine surgery is also a large financial burden on our healthcare system and I believe that the services I provide often lead to significant cost savings.
I was dismayed to learn that CMS has instituted very large (over 50% in some cases) cuts in payments for these important pain treatments; changes that were not included in the July proposed schedule for 2014. When I started my practice, I understood that some changes might occur from year to year, but had no way of anticipating such a sudden and radical cut. It is simply not practical for me to make business plans or hire new employees when I am at risk for such unfair modifications to occur out of the blue. As a new physician in my community, my income is quite modest compared to most doctors. With this major cut, I am worried that I may not be able to sustain my new medical practice at all. We have a new baby at home and my family is concerned about this sudden economic uncertainty.
It is particularly insulting to see how little of a value is placed on the knowledge and technical expertise required to perform interventional spine procedures. For instance, cervical epidural steroid injections are procedures which require me to maneuver large needles within one or two millimeters from the spinal cord in the neck. In the wrong hands, such a procedure could paralyze and permanently disable a patient. But with my training, this procedure has helped my patients to safely remain at work and avoid risky and expensive spine surgery. Nevertheless, the 2014 proposed schedule has cut reimbursement for this procedure (CPT code 62310) by over 58%, to $105. For physicians who perform this procedure in a surgery center or hospital, the payment will be reduced to a mere $70. My patients pay more than this for a massage!
Adding insult to injury, and for reasons I simply do not comprehend, the same fee schedule increases payment for the same procedure to hospitals by 18%, from $566 to $670. In other words, if a cervical epidural injection is done in a medical office, CMS makes a single payment of just $105, but if the exact same procedure is done in a hospital, the cost to the government will be increased to a whopping $740 ($670 to the hospital and $70 to the physician)! I do not understand the rationale for incentivizing a more expensive way of providing the same service to Medicare patients. Hospital executives stand to profit handsomely at the expense of taxpayers and independent physicians. Ironically, if I am forced to close my practice, I will likely go to work for a hospital, where the same services I provide Medicare patients will now cost the government several times as much as they do now!
I do not believe that I am entitled to become rich at Medicare’s expense. I simply ask for fair compensation for work that requires certain expertise, and enough stability and predictability in payment trends that I am not in constant fear of an unexpected catastrophic change in my business revenue. As a small business owner, I don’t know how to plan for the future when such changes are made without warning or even an opportunity to comment in advance. As a doctor, I can’t promise my patients that I will continue to be available to help them manage their chronic health problems in the years to come. It is in the best interest of patients and taxpayers that costs be kept in check by reigning in spending on unnecessary hospital facility fees, rather than the physicians who are already paid much less for providing the actual medical service.
Sincerely,
_____
