Meanwhile, hospitals, do you see the hand-writing on the wall? Academic medical centers have the most to lose here: There is no natural constituency in Congress to provide high levels of support for graduate medical education to these high-cost hospitals. While there is a community hospital in every Congressional district, academic medical centers are much fewer in number and concentrated in just a few districts. Count the votes.
Today's New York Times graphic confirms this, listing ideas under consideration by the Senate Finance Committee:
• Establish an “automated mechanism” to rein in Medicare costs like the one used to close military bases.
• Reduce geographic variations in Medicare spending by cutting or capping payments in “areas where per-beneficiary spending is above a certain threshold, compared with the national average.”
• Cut special Medicare payments to teaching hospitals.
The first item would likely exclude those innovative, but often high-cost, diagnoses and therapies that get their start in academic medical centers.
The second item would reduce reimbursement rates where AMCs are often located, in urban areas that require higher wages and salaries for hospital workers.
And here's the code for the third item. Those "special" payments are what fund graduate medical education -- the residency programs that train the next generation of doctors.