At the time this article was written (October 30, 2012), there are potential cuts to the physician fee schedule that could dramatically impact how physicians practice medicine and even whether or not they keep their doors open. By the time you read this, an intervention by Congress is possible and something we are all hoping for. Sean M. Weiss

EXCLUSIVE interview was held at the 2012 HBMA annual conference, Washington, DC. Visit www.hbma.org for more information.

  For 18 years I have been blessed personally and professionally to be able to surround myself with not only exceptional people but also with some of the brightest minds

Recently I had the honor and privilege of spending time with former Speaker of The House and Republican Presidential Candidate Newt Gingrich at the HBMA conference in Washington D.C. where Mr. Gingrich was the Key Note.

Prior to the Speaker's address, I spent some time with him gaining insight into a few key areas in healthcare that impact physician practices, hospitals, those of us working in the industry, and most importantly, all of us as consumers of healthcare services.

I found the speaker to be candid in his remarks and quite willing to call things "the way he saw them." Regardless of party affiliation, there is no denying that we still have major issues in our industry and without immediate steps in a direction that could impact the current delivery model and reimbursement system, no one really knows what healthcare will look like as we move forward.

We have Obamacare that is supposed to provide all Americans with healthcare via individual mandates and penalties for not purchasing insurance, which depending on the side of the aisle you sit is either a great thing or a really bad thing, but the costs to employers are continuing to drive many solo, small, and even some larger groups to sell out to larger health systems or close their doors and go to work for someone else. There are significant looming cuts to the physician fee schedule in 2013 unless Congress intervenes, which given how well the current Congress has worked with the current President and his administration, I am not sure we will see anything happen before the new year, which means the 27% cut to the fee schedule is a very real possibility.

I hope all of you reading this interview find it as enlightening as I did and are encouraged to work with your physicians to get more actively involved and to pressure their society to take a more aggressive position on the hill to stand up for the rights of physicians and to preserve our industry. 

Interview:

Sean Weiss (SW):
Good afternoon Mr. Speaker, it is really nice to see you again. As you know, BC Advantage is on the side of the business of medicine and helping physicians to understand what's going on in the industry and why they need to be paying closer attention from a non-partisan standpoint. One of the big things that is coming up in January of 2013, as you know, is the potential for a 27% reduction to the fees for physicians.  What is it that Congress can do?

Newt Gingrich (NG):
What Congress needs to do is fundamentally rethink the entire payment plan.  This annual dance is destructive to doctors.  It's destructive to the cost of healthcare.  It adds a level of administrative cost that is unnecessary.  It adds a level of uncertainty that is destructive, and it diverts Congress from solving the problem and into playing games every year. 

So I think that this is an experiment (SGR) that didn't work and has to be rethought from the ground up.  There are ways to take dramatic amounts of money out of the cost of healthcare.  There are methods that would actually, I think, if you look at the amount of fraud in the system, we could move towards the kind of efficiencies you get with American Express, Visa, and MasterCard, and that kind of accuracy.  The case I always cite is the dentist in New York who filed 982 procedures a day, and because it was paper based, it didn't come through and they didn't automatically flag it.

I think that there are a lot of things we can do to make the health system more productive, more oriented to the patient, have less friction, and I think part of it, as you know and as the companies here know, is to go to a modern, all electronic system.  When I was told that the auditing still requires paper, you know everything you need to know about how inefficient the CMS is.

SW: Just to build on that question, with the looming physician fee schedule cut in January, what can physicians hope for in a year where there are again looming tax problems with the end of the Bush era tax cuts and with sequestration being held over the defense industries' head?

NG: Well, I think the level of chaos that's coming is almost unmanageable and I think that we have had leadership that is backed into a corner where between taxes, spending, the debt ceiling, and all the different cliffs ahead of us that it looks very much like an Indiana Jones movie.  I think that it's very important that doctors develop two things.  One is- help their member of Congress to understand how to create an efficient system that focuses on allowing doctors and patients to do their jobs. And the second is to think through, and this really worries me in the long run, under what circumstance would doctors be willing to tell their children to go into medicine.

SW: Yes, because most physicians right now encourage their children to go into a field other than medicine.

NG: And clearly one of the things that you do almost immediately is Tort Reform.  If you took the cost of medical malpractice, behavior designed to avoid malpractice suits, which we did a study with Jackson Health that suggested that there is maybe as much as $800 billion dollars a year in defensive medicine, and you took the cost of inefficient paper based systems, and you took those two together, you could save more money over the next decade while paying the doctors 100% of what they ought to get.  And not playing these kinds of SGR games. 

Candidly, I spent a decade at the Center for Health Transformation and wrote a book called Saving Lives and Saving Money and I couldn't break through. I mean, the determination of Washington to avoid thinking was greater than my cleverness at getting them to think.

SW: Now that the Supreme Court has upheld Obamacare and namely the individual mandates, what are your thoughts?

NG: I think, first of all, that his (Chief Justice Roberts') ruling was wrong and that it was a mistake by Roberts to end up siding with four liberals and a really distorted position.

I wrote a small electronic book called No Taxation by Misrepresentation and it outlined the whole case.  It's amazing how dishonest [the ruling] was, particularly on the part of the Obama administration.  Again this is coming down to the presidential election.  If Obama is reelected, we are going to keep Obamacare in some form.  If Obama is defeated, we are going to largely repeal it.

SW: What do you think should be repealed?  Do you think the whole act should be repealed?

NG: I would repeal the whole bill because I don't think you can trust the stats.

SW: Even with the popular parts?

NG: I would immediately pass the popular parts as freestanding legislation.  You could have six months for the implementation of the repeal, so you'd have plenty of time to pass the parts you want to keep.  But I would never try to repeal 80% of the bill because I so fundamentally distrust the legislative stats.

SW: One last question and this will be the fun question where you can share with our readers who have never heard your position on healthcare your thoughts.  What would healthcare look like under a President Gingrich?

NG: Well, with the help of the Congress, it would be very doctor-centric, very patientcentric.  It actually would be focused first on health, which means you try to get people before they are patients.  I think that the cell phone is the public health system of the future.  And I think that there are so many things we can do to help people have better health by having them self-assess and understand the cost of their behaviors, etc. 

I think you need a really fundamental rethinking of the delivery system.  But I'd go back to building a nature of free society.  You have to have some serious responsibility for your problems and your health, and then you have to have access to a first rate doctor and to a medical system including nurses, and pharmacists, and dentists; I always tell people, as complicated as National Security is, health is ten times more complicated.  And people don't appreciate it.  That's part of why it is so hard to solve.

Sean M. Weiss, CPC, CPC-P, CCP-P, ACS-EM, Vice President and Chief Compliance Officer for Doctors-Management, specializes in audit and appeal representation for large and small healthcare practices that have been targeted by federal (Medicare), state (Medicaid), and commercial insurance payors. Sean has worked with thousands of physicians, medical practice groups, hospitals, and medical management societies, and he is recognized as an expert in the field of medical compliance. Sean delivers measurable financial results for healthcare facilities and helps physicians deliver quality care without sacrificing government compliance.

sweiss@drsmgmt.com
800-635-4040 X 123
DoctorsManagement, LLC
http://www.doctors-management.com/

About HBMA: Healthcare Billing & Management Association Elevating the Profession through Education, Advocacy and Cooperation.
A non-profit, member-led trade association, the Healthcare Billing & Management Association (HBMA) represents more than 30,000 employees at well over 700 third-party medical billing firms. Annually, HBMA companies submit more than 350 million initial claims on behalf of hospital-based physicians, office-based physicians and other allied healthcare providers. Founded in 1993, HBMA and its members foster personal development, advocate on the behalf of the profession, and promote cooperation through a wide range of business resources, educational events, networking opportunities, certification programs and adherence to the Medical Biller's Code of Ethics.

As the only trade association representing the interests of medical billers in Washington D.C., HBMA works with legislative stakeholders and federal agencies to improve the business of medical billing and the practice of healthcare. www.hbma.org