“MACRA/MIPS population health is the problem. Individual healthfreedom is the solution.”

Dear Congress & CMS,

The original stated goal of Medicare in 1965, to give healthcare to those at the end of life—when life expectancy was about 65 years—was credible and laudable. However forcing all citizens to participate in Medicare, and pay hard earned dollars into a system that they don’t want to use is not laudable, especially given the expanding government interference in Medicare which exponentially increases under MACRA/MIPS.

The original 18 page legislation declared:

“Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services….” Continue reading

Urgent Letter to ALL Physicians: Take Action to STOP MACRA MIPS Rules


Please read the following letter on MACRA MIPS current rulemaking pending with CMS. The report is the unanimous result of a comprehensive review by the National Physicians Council on Healthcare Policy. NPCHCP.org

Consider taking action to formally comment on and prevent the MACRA MIPS rules from taking effect as they would damage the patient physician relationship and would drown care in the red tape of private personal data collection, data manipulation and care reimbursement denials for years to come. Please distribute it to all members for each individual physician to consider action.

All physicians must take a stand to resist giving of the federal government, all insurance companies, and their designees unfettered access to all patient and physician private privileged information.

May 15, 2016

For Urgent Consideration

This letter is from The National Physician’s Council on Healthcare Policy. We are a national organization comprised of physicians from many different specialties from a majority of states. In 2009 the Council was established by members of the US Congress for the purpose of gathering practicing physician’s input on issues relating to medicine and surgery.

The Council has read and critiqued the nine hundred and sixty two pages (962) of CMS Rules spawned from the MACRA Law. By unanimous opinion, even if the stated goals were laudable, the MACRA Rules as written are impossible to implement and will, like the ACA, waste billions of taxpayer dollars and practice man-hours if they are allowed to proceed forward.

MACRA/MIPS will destroy the practice of medicine, taking out the solo and small groups first as physicians buckle under MACRA’s financial burden and become salaried employees or leave practice. Implementation will force physicians to betray the Hippocratic Oath by linking payment to the collection of intimate and private data on all patients. (made available without restriction to CMS and related government entities via the electronic medical record – per the regulations ). In effect, it is restraint of trade and a means to redistribute dollars from the small group practice to the large group practice.  Most importantly, it is not a legitimate means of providing the highest quality of care that our patients deserve and ironically it will not cut costs.

Further, mandatory reporting and participation in shifting government domains is to be used for bureaucrats to publically grade physicians on the pretense of quality. These misleading quality parameters will be used to qualify for financial reward or punishment. One such domain is forced participation in alternative payment models such as Accountable Care Organizations, which are revamped capitated national HMO’s. Even the Medicare pilot projects saw more than half of the participants drop out or fail to save money. References from the Rules are available for the above statements.

In 1965, Medicare was passed with the distinct caveat that the law would in no way interfere with  the practice of medicine and surgery. In contrast, the MACRA law allows total government intrusion into every aspect of the practice of medicine, including unfettered access to every person’s personal health data. Theoretically the data gathered would be used to construct “population based healthcare” rubrics, and finally “Quality Adjusted Life Years (QALY)” to decide who is to receive what care. This law actually extends CMS reporting requirements to non- government privately insured patients. This will most certainly be challenged in court.

The frequent justification for government interference is that the current healthcare expenditures cannot be sustained. Under the auspices of enhancing quality, fixing a flawed payment system, and controlling costs Congress passed another healthcare law few had read. Ironically, the MACRA solution adds billions of dollars in IT, administrative, and software costs to physicians and the taxpayers. At the same time the law takes physicians away from the care of patients. The only winners are IT vendors, hospitals, and entities selling compliance courses and software. With strong opposition, we can stop MACRA during this CMS Rules Comment Period.

The WSJ on May 7, 2016 reported that Washington rules now impose $1.9 trillion of annual costs to the US economy, or $15,000 per household. Smaller business is the hardest hit. It is our opinion that every professional medical and surgical society has an obligation to its membership to protect the interests of its members and promote loyalty to professional ethics and moral sensibilities.

We urge you to voice opposition to this government takeover of our profession during the CMS MACRA comment period prior to June 27, 2016. We can and must do better. Our patients are counting on us.

 The National Physician’s Council on Healthcare Policy is asking CMS to exempt small physician practices of 15 or fewer physicians (CMS definition) from this legislation. If you agree, please include that in your comments.

Here is where you may make your comments. https://www.regulations.gov/#!submitComment;D=CMS-2016-0060-0068

The NPCHP thanks you for all your help.   Let’s take back our profession NOW.

You may email us at: admin@NPCHCP.org
You may call us at: 562-900-2652
You may send us slow mail at: PO Box 2225 Los Alamitos, CA 90720
Visit our website at: http://npchcp.org/

Leadership: Let patients decide what quality and value means to them

Michael Strickland, MD writes in:

In the face of CMS’ own predictions, Andy Slavitt says “Despite what the table shows, our data shows that physicians in small and solo practices can do just as well as those in practices larger than that.”

I’ll believe that he, and others like him, know what they are talking about when I see them start picking up charts, seeing patients, and relieving their danger and distress, while using the systems they are so eager to mandate. I have medicaid and medicare patients who pay me cash, because they have problems they cannot get solved by their ‘providers’ who are being directed by these people, and I openly invite Andy Slavitt, President Obama, Hillary Clinton, Zeke Emmanuel and anyone else advocating this to visit my office in Cincinnati and show us how it’s done. Continue reading

Escape MACRA with Direct Patient Care

Guest Post from Tom LaGrelius, MD – President, ACPP, http://www.acpp.md

A year ago in April, 2015 Congress passed and the President signed the repeal of the SGR formula doctors have lived with for decades. SGR was never really enforced however, since each year Congress passed temporary delays in its implementation and kicked the can down the road. Medicare participating doctors did not usually get any rate increases, but at least the draconian rate cuts the SGR would have mandated were usually blocked. The permanent repeal of SGR was hailed by many as a great advance since it directed CMS to devise ways for doctors to get paid not by the visit, but by our results. However, it still mandated that the new procedures be “budget neutral”, so there will have to be as many losers as winners. If patients were kept well and out of the hospital where the huge costs reside, doctors were to be paid more and paid less if not.

The new law is called the Medicare Access and CHIP Reauthorization Act (MACRA). If you want to read the law, it is not that long, here it is: https://www.congress.gov/bill/114th-congress/house-bill/2/text Enjoy.

Trouble is there are lots of ways to implement such a plan. With Obama’s CMS troops in charge of writing the new rules, the expected happened. CMS has written a 960 page rule, many times longer than the Act itself, that nobody likes. It will force doctors into large groups and ACOs because small organizations cannot possibly comply with its complex reporting regulations. It will kill insurance and Medicare payment based solo and small group practice which will be totally unable to comply and will lose 9% of its revenue for failing to do so. Such practices are already running on very narrow margins with 70% plus overheads and a 9% cut will put many of them out of business and force the rest into contractural arrangements with hospitals that protect them at the price of dictating what they do.

The real irony is that clearly, solo and small group practice are the practices that are currently doing the best job of keeping people out of the hospital and out of emergency rooms. Why on earth would Obama’s CMS what to kill them. (In fact, they should be exempted from this law, and efforts are underway to make that exemption reality.)

The shortage of doctors will increase as more retire prematurely. As others take salaried jobs production and access will drop further since such employment arrangements always result in doctors behaving like employees rather than entrepreneurs, with a predictable loss of productivity.

There is a third option. Solo and small group doctors can do what we have done and form direct financial relationships with their patients in concierge practice and other forms of direct practice so the drastic cuts coming in the next few years will not affect them. Already the Affordable Care Act (Obamacare) has resulted in a massive increase in concierge and direct practice conversions, and that trend will accelerate.

Employees of large companies are now actively looking for concierge and direct practice access arranged by their employers, because in this brave new world since the passage of the ACA and now MACRA their deductibles and co-pays have soared so high that they might as well not have insurance at all. Furthermore, when they try to make an appointment with a physician there are higher and higher barriers to access delaying care, which essentially amounts to denied care. So, the emergency room has become the default location of care for millions. However, investing in membership in a concierge or direct practice once again gives them immediate and affordable access to care.

ACPP should be the organization that helps these new concierge and DP doctors improve and refine their practices, give them a voice in state and federal government, and provide them with a network of like minded physicians with whom to collaborate.

So, we hope to see all of you in September at our second annual ACPP meeting September 24-25 in Las Vegas. It will be a fabulous meeting with amazing speakers and networking opportunities. I hope to see you there.

Thomas W. LaGrelius, MD, FAAFP
President, ACPP

MACRA does not measure physician quality nor improve patient care

Dr. Jane Hughes writes in with a summary of pages 100-200 of CMS’ proposed rules to implement MIPS & APMs.  

Submit your comments to CMS before June 27!: https://www.regulations.gov/#!submitComment;D=CMS-2016-0060-0068

Here are the most telling and salient points for pages 100-200.

  • All reporting has to go through EMR/Questionaires CMS approves
  • The requirements are going to increase for reporting outcome measures over next several years as more outcome measures become available
  • High priority measures to be rated are a. Outcome b. Appropriate use (not defined nor not specified who decides “appropriate use”) c.Patient safety d. Patient experience e. Care coordination quality measures
  • CMS believes MIPS “Appropriate use will minimize overuse of services, treatments or related ancillary testing that may promote overuse of services and treatments.”
  • CMS decides “underuse” of specific services that reflect “overuse” of alternate treatments that are not evidenced based or supported by clinical guidelines. CMS assures that they will seek input from various “stakeholders” as to evidenced based treatments and clinical care guidelines.
  • CMS plans to develop a.Care episode groups b. Patient condition groups c. Patient relationship groups with codes for all.
  • CMS plans to update definition of primary care services, and thinks MIPS survey will closely align with PQRS, but they state they do not know yet.
  • Doctors will bear the cost of contracting with CMS approved survey vendors to administrate the required MIPS surveys.
  • In future years there will be bonus points, girls and boys, for patient experience reports. CMS may expand patient experience measures to all payers so that everyone can be be included.
  • CMS expands reporting to non-Medicare patients to “ensure completeness” for the broadest group of patients possible. If submitting via qualified registries or EMR must report on 90% of patients. If using Medicare Claims must report on 80% patients. KEY: CMS thinks this gives a more complete picture of each MIPS eligible clinician’s scope of practice and more access to data not currently captured on PQRS.
  • CMS plans on increasing data requirements in the future.
  • Global population based measures and global outcome measures may be used by the Secretary for purposes of defining quality performance. Will use Agency for Healthcare Research and Quality (AHRQ) and Prevention Quality Indicators (PQI)in calculating total MIPS score.
  • Secretary will publish annual list of quality measures which may change from the previous year. If performance on a measure becomes so high that meaningful improvement is not possible, it will be eliminated.
  • There’s more of the same, with promises of even more rules to come.

Continue reading

Just as we warned in 2009, the news is not good: Beware ObamaCare II, aka MACRA.

Jane Hughes, MD writes in:

After wasting billion of dollars on failed ObamaCare exchanges and forcing many Americans off their insurance plans, Washington directed it’s attention to fixing Medicare. Unfortunately, the same people who orchestrated ObamaCare authored the MACRA Law, referred to as the “Doc Fix”.

Nine hundred and sixty-two pages of CMS rules were just released, and groups of physicians from across the country have now had a chance to see what’s in it. Just as we warned in 2009, the news is not good. It shifts money for patient care to data mining patient records, destroying privacy and dignity of patients, forcing doctors through payment manipulations to violate their Hippocratic Oath, and paves the way to a bureaucrat rather than your physician deciding your healthcare options. Of course all this is sold as cost control and quality enhancement. If only. MACRA implementation would be astronomically expensive, ever changing and convoluted, and would destroy individual and small group practices as we watch it implode after billions more wasted healthcare dollars.

There’s still time to stop it.

Register your protest. Visit https://www.regulations.gov/#!docketDetail;D=CMS-2016-0060 and scroll down to “Comment Now” button.

Let your Representative and Senator know MACRA must be stopped. Sometimes it’s better to cut your losses.

Taming the MACRA Beast of Quantitated Madness

Guest Post from Barbara Duck: http://ducknetweb.blogspot.com/

The Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True

I’ve been watching this for years with the way healthcare is changing in the US today and we certainly need and do use constructive and good measurements in what the industry does, but just like in the financial world, we’re starting to cross some borders here into madness where mathematical models with “no” proof of concept even are producing numbers that don’t compute and host environments that are hostile to the future of providing good care.  In other words, it’s time to take to take a step back and look at where we are and it’s not pretty nor productive in a lot of business areas today. Continue reading

Tell CMS #MACRA #MIPS is bad 4 both patients & physicians

Dear AOA leadership,

Below you’ll find for links on MACRA MIPS, the latest price-fixing and medical practice control mechanism from The President and congress via CMS. If you’ve read the legislation, you’ll find that all solo and small private practices will be eliminated over the next few years, and eventually even the larger practices will follow because of “negative payment adjustments.”

Please act immediately to exclude all practices under 10 physicians, with 10,000 Medicare patients, billing less than $1 million a year. The current exclusion is 100 Medicare patients and $10,000 a year. Further, we need to get government entities out of the practice of medicine. Furthermore, the AOA must make a plan and take steps to take back the practice of osteopathic medicine from third-party “stakeholders” as well.

#MACRA #MIPS is bad 4 both patients & physicians

#CMS slides https://innovation.cms.gov/resources/macra-intro2.html

MACRA regulations out ensuring demise of private practice

MACRA MIPS legislation

To submit a comment to CMS visit https://www.regulations.gov/#!docketDetail;D=CMS-2016-0060 and scroll down to “Comment Now” button.

Must comment by 06/27/16

Members of our profession testified on Capitol Hill and sold us out.

Dr. Kris Held’s writes in:

Members of our profession testified on Capitol Hill and sold us out. Culprits include the AMA, ACP, AAFP, and Aurora Health Care Medical Group . I just finished reading these testimonies, and clearly they are vying for MACRA’s $20,000,000 per year for the net 5 years doled out to SAN awardees and PTN grantees to “educate physicians” about MACRA and “engage” with CMS. Selling our souls.

I would love to know how much $ the AMA got as a grantee of the TCPI and as an Awardee of the SAN. The ACP, AAFP, and Aurora Group (from WI) are begging for grant/award. ACP is working with AHIP.

“The AMA is also a grantee of the CMS Transforming Clinical Practice Initiative (TCPI). As a Support and Alignment Network (SAN) Awardee, the AMA is promoting the goals of the TCPI to the TCPI network of clinicians through education about MACRA, CME, dissemination of best practices, promotion of clinical data registry use, and provision of tools and resources on APMs.”

How did these private groups get invited to testify? Who authorized the to embrace MACRA and seek $Millions is awards and grants “Educate” their members(us lowly physicians) about it? Why were other “stakeholders” not invited to the party?

MACRA is what you get when United Healthcare runs CMS

Barbara Duck, @MedicalQuack writes in:

This is what happens when you have a Quant, formerly a Quant/CEO from United Healthcare running CMS. Slavitt had not changed his spots at all and over the years United has been mentoring CMS and HHS on their models anyway, where he was in fact involved.

I’ve beat my brains out trying to bring this awareness around for years with math modeling and evil algorithms being the vehicles that drive this. Again, I can’t wait until he’s out of that office as I do well trolling him on TwitterJ That’s for real too as having my former background as an EMR programmer, I can dive right in there. The relationship with HHS and United Healthcare is so scary and has been for years and it all developed right in plane site as nobody seemed to want to even blink an eye.

So how many MDs will be driven out of private practice now and end up working at one of the over 300 MedExpress (United Healthcare owned) urgent care centers? I don’t want to see that of course, but mention it as a “part of the plan” with CMS and HHS restructuring.

This is like the Ingenix Phoenix bird resurrecting from the ashes if you will, as it’s the same math modeling that Slavitt learned at both Goldman and McKinsey corporation as that’s what they do there and look how many McKinsey consultants have gone to jail or gotten in trouble with the law, Valeant CEO is the most recent that comes to mind.