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An attack on the medical establishment buried in an 1,800-page regulation

An attack on the medical establishment buried in an 1,800-page regulation

Boston Globe5 days ago
Medicare officials have been loath to change it because it has spared them from needing their own staff and budget to make such pricing decisions, along with the unpleasant politics of adjudicating conflicts between competing groups of physicians.
But a change buried inside a 1,803-page proposed regulation published last Monday suggests the Trump administration would like to move away from this longstanding system. If finalized, it could begin overturning a process that has entrenched pay advantages for certain kinds of doctors.
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'We're modernizing Medicare by correcting outdated assumptions in how physician services are valued,' said Chris Klomp, a deputy administrator of the Centers for Medicare and Medicaid Services, in an email.
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Robert F. Kennedy Jr., the secretary of health and human services, has emphasized that medicine should focus more on primary care and prevention, and less on the treatment of advanced diseases. He has also crusaded against 'corporate medicine,' and has specifically criticized the American Medical Association. Stat News reported in November that Kennedy was considering policies to disempower the AMA committee.
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Dr. Bobby Mukkamala, the AMA's president, was highly critical of the proposed change.
'The American Medical Association believes that proposals to exclude or limit the input of expert practicing physicians and health care professionals in the development of Medicare payment policy would ultimately harm patients and represents a radical departure from the time-tested CMS decision-making process,' he said in a statement.
The current AMA committee, known as the RUC, uses data gathered in surveys of doctors to set formulas for every kind of medical care. The committee suggests payment rates to Medicare's regulators, who almost always adopt them. The system is effectively zero-sum — any increases for one kind of doctor represents decreases for others. While private insurers are free to develop their own formulas for paying doctors, they tend to follow Medicare's lead, making the committee very influential on what kinds of medical care get the largest (and smallest) financial rewards.
The estimates are often outdated. Existing payments are reviewed on average only once every 17 years. A Washington Post investigation in 2013 reported on numerous gastroenterologists who had billed Medicare for more than 24 hours' worth of colonoscopies a day. The reason wasn't fraud. Medicare was still paying the doctors as if each test took 75 minutes to complete, when most doctors were able to complete one in 30 minutes. (The colonoscopy payment has since been adjusted.)
Under the new proposal, Medicare would pay 2.5 percent less for every procedure, operation and medical test in 2026, based on data suggesting there have been improvements in 'efficiency' over the years. Payments for treatments based only on time, like a consultation with a family physician or neurologist, would not be cut. Such adjustments would be repeated every three years.
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The proposal also looks to change the kind of data Medicare should consider instead of the relatively small surveys, noting that new sources of health data from hospitals and electronic billing systems could offer more accurate information.
The effort to adjust what doctors are paid for their work is just one part of the large rule, which also contains provisions to broaden coverage for telemedicine, pay for more mental health care, and reduce overpayments for a new and expensive type of skin bandage.
One other provision, meant to better account for the costs of running a medical practice, also affects the relative pay of different medical specialists. In some cases, those changes would reduce payments to the types of medical specialists whom the efficiency adjustments are meant to benefit.
That policy would adjust payments to doctors based on whether they offer services on a hospital campus or in a private practice office, effectively lowering payments in the hospital and boosting those elsewhere.
Taken together, the overall proposal would do more than just increase the salaries of primary care doctors. It would also increase the average pay of an allergist next year by 7 percent, and decrease pay for a neurosurgeon by 5 percent, according to estimates published by Medicare. It would lower pay by 6 percent for infectious disease specialists, who tend to earn low salaries and perform few procedures -- and increase average pay for vascular surgeons by 5 percent.
Dr. Adam Bruggeman, a spine surgeon in San Antonio who leads the council on advocacy for the American Academy of Orthopaedic Surgeons, said he was sympathetic to arguments that the current system may be paying for some medical procedures inaccurately. But he said the proposal — which would cut payments for all procedures next year — was too crude a solution to that problem. He described the 'efficiency' changes as 'taking an ax to the whole thing.'
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'We're just fighting an arbitrary number with another arbitrary number, and that doesn't help,' he said.
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Official fired during President Donald Trump's first term appointed president of embattled US Institute of Peace
Official fired during President Donald Trump's first term appointed president of embattled US Institute of Peace

Chicago Tribune

time3 minutes ago

  • Chicago Tribune

Official fired during President Donald Trump's first term appointed president of embattled US Institute of Peace

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Sunday shows preview: Trump remains embroiled in Epstein drama as tariff deadline looms
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  • The Hill

Sunday shows preview: Trump remains embroiled in Epstein drama as tariff deadline looms

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Photos: Hundreds in S.F. form human banner during ‘Families First' protest of Trump
Photos: Hundreds in S.F. form human banner during ‘Families First' protest of Trump

San Francisco Chronicle​

time3 minutes ago

  • San Francisco Chronicle​

Photos: Hundreds in S.F. form human banner during ‘Families First' protest of Trump

Hundreds of people gathered at San Francisco's Ocean Beach to form a human banner Saturday morning as part of a nationwide 'Families First' day of action against the Trump administration. As an upside-down American flag flapped in the misty San Francisco summer air, the protesters stood in straight single-file lines near the Cliff House, forming 'FAMILIA!' below letters spelling 'WE ARE.' Children, parents and grandparents, many accompanied by dogs, protested what organizers from Indivisible SF called 'cruel cuts and attacks on our families' by President Donald Trump, including changes to social programs, food stamps and school lunches, 'all so a handful of billionaires can get tax giveaways.' The protest took particular aim at Trump's One Big Beautiful Bill Act, the budget he recently signed into law, which cuts nearly $1 trillion from Medicaid over the next decade and is expected to mean millions of Americans will lose health coverage. Protesters also decried recent raids in the Bay Area and nationwide by Immigration and Customs Enforcement. As a ukulele band played Woody Guthrie's 'This Land is Your Land' over speakers, Peter Hosey, 40, stood in a line of people forming the letter 'A' in 'FAMILIA.' 'The message today is 'We are familia,'' Hosey said. 'That certainly resonates for a lot of us when you see what ICE has been doing, deporting children, deporting mothers, putting people in camps.' 'This is not what our country should be,' added Hosey, who works in the tech industry. The crowd, which organizers estimated as 600, then headed to the ocean, raising hands and waving to the water. Protesters then walked back and formed a circle around a large American flag as Sister Sledge's 1979 hit 'We Are Family' played over the speakers. Micki Morales, a retired schoolteacher who lives in Cupertino, was standing in one of the human letter lines when a call went out over the speakers. 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'How is it fair that families like mine up and down the state of California have lived our whole lives trying to move up and move forward for our kids, and we just can't?' Arreola, the mother of three children, said in a news release before the protest. 'My closest family members are on Medi-Cal: my dad and my grandparents. My daughter needs eye surgery. These cuts put our lives at risk.' In San Jose, health care workers, patients, community leaders and educators gathered Saturday afternoon at Discovery Meadow to highlight the effect of immigration raids and corporate tax breaks on working families. The Bay Area protests were organized by a coalition of unions, advocacy groups, faith leaders, and families. Events were also planned in San Mateo, Colma and Novato. The 'Families First' day of action included hundreds of rallies in all 50 states, highlighted by a livestreamed mobilization in Washington, D.C. The Washington demonstration included a 60-hour vigil at the National Mall to protest cuts to federal programs benefiting families. The events follow anti-Trump rallies that drew tens of thousands of people around the Bay Area and nationwide, including No Kings Day in June and 'Hands Off' in April. The San Francisco protest was organized by the same people who spelled out 'No King' on Ocean Beach during the nationwide No Kings protests this year. Several drones hovered overhead to capture their latest message. When it came to keeping the participants in orderly lines to spell their message clearly for the drones overhead, the job largely fell on Brad Newsham, 73. Newsham, a writer and former longtime cabdriver in the city, has been organizing protests like this one since 2007. Their causes have spanned the eras, from calls to impeach President George W. Bush, to support for Occupy Wall Street and now opposition to Trump. 'This is No. 28,' Newsham said. 'This has been incredible.' Newsham walked around the sand in a bright yellow jacket Saturday, delivering orders to the crowd via bullhorn. His injured ankle didn't hold him back. 'It's cool when you get a shot from the sky of all these people,' he said. When a group of protesters wearing purple union shirts bunched up in a line that was supposed to be single file, Newsham whipped them into shape. 'Hey SEIU, squeeze in!' he shouted into the bullhorn. 'It makes a better picture, you can do it.' Newsham seemed to get a kick out of it. 'It's an awesome responsibility,' he said. The demonstrators spelled out 'FAMILIA' to protest what Newsham's co-organizer, Travis Van Brasch, called ICE's 'completely illegal, cruel, stupid, unnecessary' raids. 'We are saying it in Spanish because that's where most of the trouble is,' said Van Brasch, 72. Warren Pederson contributed to this report.

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