Jeff F. Lin

Physicians keep seeing our Medicare rates slashed (down 20% since 2000). Yet, the Medicare program is still facing insolvency. Medicaid spending is the largest share of state budgets. Both programs continue to grow at a faster pace than the overall economy. Can spending be curbed without further harming patients? Yes. In an excellent @Health_Affairs piece, Deborah Williams, @DrBrian4Health, @MedicareMeddler, @betty_rambur and @gailwilenskycom outline pragmatic, realistic steps to reduce costs without hurting patients. 1- Site neutral payments: Why does a hospital clinic get to charge more for the same office visit as an independent practice. Fix this loophole. 2- Reform GME funding: The money that hospitals get in exchange for training residents is not commensurate with the costs. Hospitals are expanding residency spots without GME funding, so there's clearly a market force at work. 3- Equalize tax treatments for investments: 93% of hospital holdings are unrelated to their core mission. Taxing these gains could provide needed funding for a variety of programs. 4- Fix state funding of federal funding schemes: Since the federal government reimburses states for Medicaid spending, states use a variety of accounting tricks, such as provider taxes and 340B, to get more funding. This is essentially robbing Peter to pay Paul. Policy is complex, but physicians must understand these issues so we can advocate for financially responsible, patient-centered care. Neurosurgery training is nothing compared to this! healthaffairs.org/content/fo… @ucsf_ihps @cscla @AnilMakam @VPrasadMDMPH @EconTalker @neurosurgery @SpineNeuro @JPGK_MD @JoanneSpetz