Health Care Reimbursement System Might Lead to Shortages of Certain Specialists, Experts Say

Health care policy experts have raised concerns that the current health care reimbursement system "favors high-tech procedures over low-tech exams" and has helped "create shortages among primary care doctors," but "often lost is how the system is endangering some of the country's most highly trained specialists," such as endocrinologists, rheumatologists and pulmonologist, the Wall Street Journal reports.

In the early 1990s, CMS implemented a new system that established standard Medicare reimbursements for physician services, and private health insurers since have implemented similar systems. The system sought to "clamp down on prices and, ironically, narrow the disparity between the bread-and-butter office visit and more expensive specialty procedures," but many health care policy experts "argue Medicare's fee-setting mechanisms are making those disparities worse," the Journal reports. According to the Journal, the system "still rewards the capital expenses of new technologies and is slow to reduce those fees as costs depreciate and physicians learn to perform procedures faster," but "it hasn't significantly increased fees for lengthy and complex patient visits, which are much harder for doctors to make more efficient without harming patient care."

Some experts maintain that any shortages of specialists will "correct themselves on their own," but others maintain that a decrease in the number of specialists in certain areas could lead to problems for patients who require proper diagnosis and treatment, according to the Journal (Fuhrmans, Wall Street Journal, 5/5).

Physician Assistants
In related news, the New York Times on Monday examined how, as patients "live longer and chronic diseases grow more and more complex," health care experts "project a shortage of doctors and an even stronger demand for physician assistants."

Physician assistants perform 80% of the duties of physicians, but they receive only about 50% of the average salary of physicians, or about $82,000 annually. According to the Physician Assistant History Center, the U.S. currently has about 68,000 physician assistants (Ramirez, New York Times, 5/5).