New Medicare MACRA/MIPS Penalty Hits Solo & Small Groups Hardest – Open Letter to AOA and AMA

Dear AOA and AMA leadership,

Has anyone at AOA and AMA that enthusiastically supported MACRA actually taken the time to read it this week(links below)? It is a statisticians nightmare. When applied to the practice of medicine, it is a plague. It is more onerous than meaningful use and the sustainable growth rate that it replaces. Not only does it penalize solo and small practice physicians, but controls the practice of medicine through reimbursement and procedure micromanagement based on government MIPS data. 

We practicing physicians knew this when the AOA and AMA were busy jumping on the government bandwagon for change at any price. We are out of the frying pan and into the fire, ladies and gentlemen.

What will the AOA and AMA do to champion the cause of solo and small practice private medicine in the face of ACA, ACO and MACRA disaster? Try DPC-Direct primary care unhindered by government and third parties.

Everyone at AOA and AMA should attempt to read it as we concerned physicians are this week.

Commentary:

New Medicare Penalty Hits Small Groups, Solo Physicians Hardest

Whole MACRA here:

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10032.pdf

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Host of Your Health Matters

Rowan Radio 89.7 WGLS FM

http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS

Twitter @drcraigwax

ICD-10 Red Tape 101

How would you go about describing ICD-10 and its shortcomings to the public?  Recently a student asked for an explanation of ICD-10 and Parth Desai of http://www.icd10charts.com/ provided a superb reply:

Hi Austin,

Great question! I’ll be brief with my explanation, but if you need any more information I’ll be happy to answer it a little more thoroughly after my last test for school is done next week.

ICD-10 CM is the new medical coding system that was implemented by the federal government on October 1, 2015. This coding system replaced the previously used ICD-9 system which was in place since around 1979. ICD-10 was a highly controversial system because of how large of an administrative burden it posed on medical practices, particularly for private practice physicians. It was so controversial in fact that ICD-10 was delayed 3 times over the last 10 years by Congress before it was finally enacted last year. Now before I go into the real issues with ICD-10, let me quickly explain how physicians get paid by insurance companies using these codes.

Free Advertising for ACCME Masquerading as Article in NEJM

Via Paul Kempen, MD, PhD:

Everyone should review this free article in NEJM from the CEO of the ACCME. Clearly  profit oriented propaganda for ACCME and MOC! I encourage EVERYONE to make a comment on this article! My comment is as follows-hopefully will be published!

See: http://www.nejm.org/doi/full/10.1056/NEJMp1515202

CLICK HERE to view the ACCME 990 form.

Paul

This article is concerning. It is free advertisement for the ACCME (a $12 million gross receipts a year “business”) as well as the increasingly suspicious ABMS MOC industry (earning over $400 million cumulatively each year) . The most recent IRS 990 form from 2014  lists the CEO salary at over $450K annually-whereby Graham McMahon is also listed as “principal officer” in 2014, yet without indication that any money was paid. This is 2016, He is CEO. Anyone reading this article MUST recognize it as a free advertisement for corporate products. While such “public service” to physicians is given 501-c tax free status, we must all recognize that physicians are forced to buy these products. True competition does not exist with such 501-c corporate monopolies! These monopolies are historic legacies and deserve serious consideration in this millennium, even though the AMA support reached back 100 years!

It is time to review the many corporate monopolies extorting payments from physicians without FREE choice! YES,  changes to post graduate education must ELIMINATE extortion of physicians to learn from corporate products. Non-profits must start offering FREE service or lose exempt status!!!

Oklahoma Governor Signs Anti MOC/OCC Legislation!

An Oklahoma physician writes in:

Yesterday, April 11, 2016 our Governor signed a bill preventing entities from using MOC or OCC as a condition for licensure, reimbursement, employment or admitting privileges at a hospital.

Click here to read SB 1148.

This is HUGE!!! We essentially blocked ABMS and AOA lobbying efforts and hopefully blocked the Interstate Compact law (which we successfully squashed for this year’s legislative efforts).

This may be a model to squash MOC and OCC forever.

Note: This victory follows Kentucky’s anti-MOC, bill SB 17, passed earlier this year.

Educating Legislators about Dangers of Interstate Medical Licensure Compact

Is your state considering entering the Interstate Medical Licensure Compact?  Educate your legislators about why this is a bad idea. Below is a sample letter you can use to assist your outreach efforts.  Even if your state isn’t yet a target start educating your legislators and colleagues today!

Dear Members of the Colorado House of Representatives,

Thank you for your dedicated service to the citizens of Colorado.

We are writing to voice concerns about HB 16-1047 which, if passed, will sign Colorado on to the Interstate Medical Licensure Compact. The Interstate Medical Licensure Compact “may seem like a positive step” at first glance, warns CATO adjunct scholar Shirley Svorny, PhD.  She continues, “[t]he compact is being promoted, disingenuously, as addressing license portability and access to interstate telemedicine…. Adding the Compact Commission creates another layer of bureaucracy and costs.”

States that are closely looking at the Compact are increasingly rejecting it and exploring other state-controlled policy options to better accomplish the goal of license portability.

Maryland Rejects Interstate Medical Licensure Compact … Again

Maryland’s Compact bill (SB0446) was withdrawn for 2nd year in a row after an unfavorable Senate committee recommendation. http://mgaleg.maryland.gov/webmga/frmMain.aspx?pid=billpage&stab=02&id=sb0446&tab=subject3&ys=2016RS

The Maryland State Medical Society testified that they are concerned about disciplinary provisions in compact. Since the Compact can’t be amended the society suggests fixing reciprocity problem at the state level. There are two bills pending that address license portability on a state level in lieu of joining the Compact: SB 1020 & HB 998.

The Maryland Medical Board testified against compact. There are too many details yet to be worked out. “We are worried about the bureaucracy.” The board also expressed concerns about the “extensive” disciplinary threats. “Fees could become quite excessive.” We are in wait and see mode. Physicians could get a license through the Compact without meeting Maryland’s licensing criteria. The board supports state-based reciprocity bills outside of the Compact.
http://mgahouse.maryland.gov/mga/play/d0306176-a3eb-4e70-bbeb-0c81c918dcca/?catalog/03e481c7-8a42-4438-a7da-93ff74bdaa4c&playfrom=1075000

For more on what’s being said about the Compact in other states see: https://goo.gl/obwZe3

HSAs Need A Makeover: Meet the Health Empowerment Account

Comrades in arms,

Thank you for working to bring back true low premium high deductible health insurance that reimburses patient for catastrophic losses and health savings accounts. Current HSAs are fatally flawed as they are currently limited in use scope and inexorably tied to health insurance. Here are some principles to help. If the HSA is limited by definition, perhaps we can advocate for a new concept like “health empowerment accounts(HEA).”

1. HEA/HSA should be one to each individual from birth or whenever they are added on. They should belong only to that individual unless lawfully transferred to a family member(see 3).