Written by Larry Sobal, CEO, Appleton Cardiology Associates

Don't get me wrong, as the Senate and House move to merge their reform bills, there are many aspects of health reform I'm supportive of. But a few are causing sharp pains in sensitive areas. Here's the lurid details.

Pain No. 1: Last week both the Senate and Congress passed similar legislation supposed to help physicians. The temporary "doc fix" delays, from January to March, some major cuts in Medicare payments to doctors.

Physicians have been waiting a long time for Washington to fix Medicare's sustainable growth-rate, or SGR, formula, which determines physician payment for treating Medicare patients. Congress has stepped in every year since 2003 to enact a temporary fix so that doctors wouldn't experience reductions to these payments. Despite most people in Washington agreeing the current formula is awful, this annual process of pushing the cuts to a future year have amounted to a massive 21 percent or more reduction for 2010.

I agree, delaying the cuts beats the alternative, but it also plays havoc (i.e. jerks around) the medical practice industry since for some groups, like Appleton Cardiology, this represents millions of dollars of uncertainty. Our patients and employees are bearing the brunt of this indecision through eliminated or delayed plans.

Pain No. 2: Tort reform is not addressed in any meaningful way in either the House or Senate reform bills. Why is it important? Leaving the tort system "as is" ignores more than tens of billions in potential savings in health care at a time when we are struggling to figure out how to foot the bill for the overall reform proposals.

Don't believe me? The nonpartisan Congressional Budget Office — historically cautious about claiming any cost savings whatsoever from tort reforms — determined that tort reforms (damage caps, joint and several liability changes, and collateral source reforms) would net $54 billion alone in savings over the next decade. Experts think the CBO probably underestimated the totals and some laud savings as high as $200 billion.

Here's the stabbing pain. Wisconsin had been a national leader in tort reform until a 2005 State Supreme Court decision eliminated some of its effectiveness. Nonetheless, we are still better than some states. However, language in both the House and Senate reform bills create powerful financial disincentives for state legislatures to continue the type of reform that remains in Wisconsin.

Pain No. 3: As of Jan. 1, Medicare and Medicaid plan to eliminate various billing codes that specialist physicians, such as cardiologists, oncologists, and surgeons, use to bill for medical or surgical consults at the request of a practitioner who wants a specialist's opinion regarding his or her patient. These consultative codes are supposed to pay the specialist for performing an independent physical, getting a separate history of the patient, spending as much as an hour to set a correct diagnosis and returning to the referring physician a written report of the findings and recommended plan of care in the outpatient setting. Hum, this must not be that important,

I hope that Uncle Sam is giving you better gifts for your holiday.