Independent Doctors Under Attack

May 4, 2016

 
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The Obama Administration wants solo practices to disappear. The Center for Medicare and Medicaid Services (CMS) has issued a 962-page proposed rule that will hurt 87 percent of solo practices (89,383 clinicians).
 
POLITICO reports, “That’s roughly $300 million in penalties for nearly 100,000 doctors.” (See fourth and ninth columns in first line (“Solo”) of tweet below and don’t miss Farzad’s “financial suicide” comment)
 
 
The GOP’s Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) mandates this devastating Merit-Based Incentive Payment System (MIPS). Data reporting begins in 2017 and penalties of up to 4% begin in 2019.
 
Andy Slavitt, CMS administrator (and former executive of UnitedHealth Group, the nation’s largest HMO), cheered the regulation admitting in a podcast: “I think we have, in the process of trying to put a lot of good ideas in place, really lost the hearts and minds of physicians who practice medicine every day.”
 
I don’t buy his concern. MIPS will keep the pain going. Although CMS’s Slavitt trumpets MIPS as a “transformative opportunity for the Medicare program,” protests have already begun. Anders Gilbert, senior VP at Medical Group Management Association told Medscape:
 
It’s inconsistent with the congressional intent, and inconsistent with what CMS has been saying, that they would make (MIPS) so much more difficult for physicians in anything but a mega-practice.
 
Slavitt hails MIPS’s “measurement and reward” system saying, “No one would argue with the concept of paying based upon the quality of care delivered to our beneficiaries. Everyone would salute that.”
 
I’m not saluting. “Quality” is whatever Slavitt & Co. deems it to be, including rationing of care. How many patients and doctors support penalizing doctors for failing to practice medicine the government way, or mandatory reporting of their medical data to government? NOTE: data from ALL patients must be reported under MIPS (p. 400):
 
 
The much-hated federal EHR “Meaningful Use” (MU) mandate, which led to many lost hearts and minds – and massive transition from private practice to employed physician status for many doctors due to its cost and complexity -- is now being wrapped into MIPS and renamed the Advancing Care Information program, which is one of four performance categories doctors must achieve to get fully paid. The new MU:
 
 
Imagine how the above scoring system might mean your doctors are relegated to focusing on meeting its demands (and three other scoring categories) rather than you, the patient!
 
Data for scoring are tracked using electronic health records (EHRs). “Meaningful Use” (MU) forced most doctors to buy, install and use an EHR “meaningfully” or face penalties regardless of the dangers EHRs present to patients and the physician’s ongoing loss of productivity and income. But Slavitt tellingly celebrates the result of the EHR/MU mandate:
 
Meaningful Use was actually successful in accomplish -- in getting us to I think a certain place, and that place was you have 90% of hospitals and 70% of physician offices have computers. And remember 6 years ago, people wouldn’t invest in technology because it didn’t make sense. There was no business case. So, if we didn’t have that, we wouldn’t be able to do anything else.
 
Indeed. The Obamacare takeover requires a networked surveillance system in every exam room and at every hospital bedside with data accessible to government officials and health plan collaborators. Join with CCHF to end the surveillance – and restore patient and doctor control.
 
Working undeterred to restore freedom to medicine,
 
Twila Brase, RN, PHN
President and Co-founder
 
P.S. Deadline for public comments on proposed MIPS rule is Monday, June 27: Please send a comment of just two or three sentences opposing this plan to essentially end the independent practice of medicine: COMMENT AT: https://www.regulations.gov/#!docketDetail;D=CMS-2016-0060