The new perpetual squeeze on physician reimbursements
Zinberg writes on predicted effects of the Affordable Care Act on reimbursements. As 30 million patients pour into the system, half onto Medicaid rolls, and cash-strapped state governments likely reduce payments for their visits (after federal prop-up payments shrink in 2016), Zinberg asks whether most physicians will see Medicaid patients at all, since many already refuse to. The Act also assumes Medicare reimbursements will fall by 30% over the next 3 years, and stipulates steady yearly declines in Medicare reimbursements (which were sold politically as net-even, since physicians will make up for it with increased productivity), as well as a constant ratcheting-down by the increasingly empowered Independent Payment Advisory Board. Sigh. JAMA 2011;305(19):2011-2012.