Bipartisan Attempt to Control Your Doctor


July 25, 2013


Who will control your doctor? Yesterday the U.S. Energy and Commerce House health subcommittee voted to pass a version of the bipartisan 70-page draft “SGR repeal” bill that will change the way Medicare pays your doctor and other clinicians. The bill repeals a longstanding contentious system of yearly payment cuts under a law called the Sustainable Growth Rate (SGR)  -- but then it puts government in charge of doctors.

Congress has regularly passed annual “doc fix” bills to stop the SGR pay cuts. Thus, if the SGR cuts were finally allowed to take effect next year, Medicare payments to doctors would drop by 25% on January 1, 2014. Congress doesn’t want this to happen. Instead, the proposed SGR repeal bill increases annual Medicare payments by 0.5% for five years -- until 2019 when it institutes an intrusive tracking system that would put medical decisions under federal control.
In exchange for the SGR repeal, the bill would require doctors to report certain government-imposed “quality” metrics to the government or accept a 5% cut in Medicare payments.
The SGR Repeal bill requires complicity by organized medicine. If the bill becomes law, the bill allows HHS to get together with medical organizations (“peer cohorts”) to create “quality measures” and “clinical practice improvement activities” under which physicians will “be assessed for purposes of determining, for years beginning with 2019, the quality adjustment” (penalty or bonus) to Medicare payments.
Score cards will be created. Physician compliance with government-prescribed quality measures will be scored from 0 to 100. Doctors with compliance scores of 67 or higher earn a 1% bonus. Those with scores of 34 or less receive 1% less pay. The government will provide “ongoing feedback” to doctors through data systems that track their compliance with government quality (compliance) measures. The bill appropriates $100 million from taxpayers to set up the new tracking and reporting system.
This is coercion with a capital “C.” Physicians and other practitioners will have to choose between government tracking and scoring of their treatment decisions or maximum allowed compensation for care they provide to Medicare patients.

They will not get both. They may not even get one. They could be found deficient and their pay docked. Meanwhile they will be sharing private health data with government officials and their contractors.

Physicians and other practitioners will be scored on the basis of government-prescribed quality measures within five “quality domains”:

  • Clinical care
  • Safety
  • Care Coordination
  • Patient and caregiver experience
  • Population health and prevention

These terms sound innocuous, but they aren’t. The domains can be interpreted broadly or narrowly according to the Secretary of the U.S. Department of Health and Human Services (HHS). For example:

  • “Clinical care” could be interpreted to include high scores for restricting access to care determined by the government to be medically “unnecessary.”
  • “Safety” could mean mandatory use of intrusive electronic medical records, even though the FDA has testified to deaths related to EMR use.
  • “Care Coordination” could mean doctors must try to keep patients in a limited network of providers even though best care can be found elsewhere.
  • “Patient and caregiver experience” could mean patients are kept comfortable and uncomplaining by not telling them about all available medical treatment options that could extend their lives.
  • “Population health” is code for rationing. There’s no such thing. Doctors take care of patients not populations. However, “population health” advocates in and outside government want doctors to look at medical care as a “limited resource” and to take “populations” of potential patients into consideration rather than the individual patient sitting in front of them when deciding whether to provide medical care.

The SGR Repeal bill puts doctors under corporate control. Doctors who agree to join a yet-to-be-determined list of “Alternative Payment Models” (likely to include Obamacare’s corporate ACOs and “medical homes”) will not be required to file quality reports. Instead HHS will contract with a third party to evaluate quality and cost savings within each model.

The models would only be evaluated every three years to determine whether the Model had “reduced the quality of care” during the previous three years.  Pity those who suffered loss of health or loss of life those three years. But then again, it’s possible that the evaluations may not even judge those kinds of losses as a reduction of quality. It depends on the government’s definition of “quality reductions.”

This “bipartisan” bill is a bad bill. Its authors/coauthors include Republicans (Burgess, Upton, Pitts) and Democrats (Pallone, Waxman and Dingell).

Contact your members of Congress and tell them to oppose the House “SGR Repeal” bill.

Then read my 2003 article called, “MEDICARE: Need an escape plan, not a rescue plan.”  It’s still relevant, and with Medicare now sustaining a $43 trillion unfunded liability (nearly three times our national debt), it’s more urgent every day.

Isn’t it time your doctor got OUT of Medicare? Isn’t it time you begin to save money to pay your doctor cash for the care you need?

On Saturday, August 10, I’ll be speaking at an event in Minneapolis that will train doctors how to get out of Medicare: “Thrive – Not JUST Survive XUII – Building a Direct-Pay, Independent Practice.”

Do everything you can to support physician freedom. Your life depends on it!

Working with you for health freedom,

Twila Brase
President and Co-founder