One thing we all hate is the high prices we pay in the US today for our prescriptions. Sure we do get some discounts, but that too has become an effort in algorithmic shopping to click here and click there to get the best price. It shouldn’t have to be that way, but it is as that’s how the systems have been built. There are a ton of discount prescription cards floating around out there and they all vary in one way or another, but the big thing to remember about all of them is that they are a marketing firm that can and will sell your data to make money. In addition, the discount cards act just like a pharmacy benefit manager with getting all your information when you use them to fill a prescription. In addition, some of them offer referral fees so they can increase the size of their data base of patient information. Data means money today and it can be repackaged and resold over and over, and yes, that’s us. Continue reading
One aspect perhaps not getting enough attention is how MACRA doubles down on price fixing for Medicare services. It’s price fixing coupled with increasingly complicated hoops to jump through; hoops that determine if a physician will get a small percentage more or less than the fixed price. But the costs and risks of jumping through the hoops far outweighs any potential gain for a solo physician. (It’s not really about paying physicians more anyhow but controlling costs under the guise of paying for quality.)
The CMS self-styled “innovation center policy nerds” think they are smarter than the free market at determining prices. They think they can create algorithms that somehow replace free market mechanisms to tie payment to value. The problem is that decades of Medicare payment policy developed by Medicare policy experts has resulted in one failure after another; flopped Medicare policies are actually responsible for divorcing payment from value. Why should we expect they are getting it right this time?
Holly Fritch, MD points out:
MACRA violates sound economic principles. It is a false premise (repeatedly stated) that MACRA decreases healthcare costs. Nobel prize winner Coase’s Transaction Cost Theorem states that transaction costs of time, money, and effort, which increase the effort to provide care, result in higher monetary costs.
Get you comments in opposition to MACRA in TODAY! Deadline: June 27 11:59pm Eastern. Comment at: http://bit.ly/macracomment
Dear Mr. Slavitt:
CMS can be the hero that saves Medicare for our children and grandchildren by simply starting out with these three steps:
1. Take the handcuffs off solo and small practices, which are the most efficient, productive, effective and inexpensive healthcare facilities available.
The stated goal of MACRA MIPS is to make care more available, inexpensive and productive. Per government data published in Medical Economics, 89% of solo practices will get hit with penalties and a majority of small practices of less than 10 physicians, some 110,00 physicians, will be also be penalized. All solo and small practices are potentially vulnerable to bankruptcy due to MACRA.
http://medicaleconomics.modernmedicine.com/medical-economics/news/your-voice-frustrations-quality-metrics-remain-intact Continue reading
Arvind R. Cavale, MD, FACE, writes in:
I liked this comment by a Doc Holliday “This will never work. It is doomed to failure. You are killing the goose.
There will be no one to care for you who actually cares when you are old and decrepit. I hope when you are there you remember your contribution to the destruction of quality doctor-patient relationships which you helped to destroy. Oh, and forget about that physician assisted suicide you craved, we’re gonna let you enjoy your golden years. Go ahead kill all the doctors. See where that gets you.”
I see that a majority of the 483 comments are negative, like this one from my friend Jeff Mandel “While I have yet to read the 962 pages in their entirety, I have heard several CMS-sponsored presentations on the proposed rule making. I am astounded and greatly dismayed at the level of unnecessary, convoluted complexity that our government has proffered to unleash upon an already fragile healthcare delivery system. The intrusiveness into physicians’ lives, workflows, and livelihoods is unprecedented and immoral. This speaks nothing to the patient privacy issues that will arise if this abomination of legislation is approved. I can only hope that some rational thinking emerges from CMS and sanity prevails in discarding this lunacy-driven suicide plan for the independent practice of medicine – unless, of course, that is the intent. Continue reading
[Reply from Dr. Michael Strickland to a question posed, and a noted attorney’s citation of a Supreme Court decision (NYLCARE) indicating otherwise]
The government (and swarms of others, health insurers first and foremost) ARE practicing medicine without license. If the Supreme Court says otherwise, then they are either wrong, or the legislature is wrong in the law it is writing. Highly trained and experienced medical professionals are, overnight (although creeping in very slowly for years before the cultural revolution of MAObama – and I say this as one who voted for the President, and initially supported healthcare reform) being directed, day by day and minute by minute, how to practice our profession, like puppets on strings, by untrained individuals who do not assume responsibility for the consequences, as do the patient and the physician. How can it be practice without license to step into the exam room or the OR as an unstrung actor and perform these actions, and not to string and restrain highly trained actors, and perform these exact same actions on living feeling patients at their most vulnerable, and with the exact same consequences? It is no different, regardless of legal technicality. If the law or the court say slavery is right, it is still wrong! I will share the stories of a number of cases, where patients have unnecessarily suffered and died (not to mention vast sums of money wasted) as a result, if desired. Continue reading
Dr. Robert Sewell, author of A Surgeon’s Heart, replies to comments by AMA President Steven Stack’s comments about MACRA:
This statement from Stack is the exact same Drivel we heard from the AMA surrounding the passage of the ACA. “Don’t worry, we will revisit it every year and we’ll make it better.” To that I have only 2 words and they start with the letters B S. AMA “Leadership” is in the tank for the government and their total take over of medicine. No matter how the AMA tries to soft-sell all this crap, it is clear they are satisfied because they’ve salvaged themselves by making a deal with the devil. I say to hell with them. This is why I left the HOD in 2013 after four years of actively trying to change the organization from the inside. It can’t be done. Unless you are willing to play along with their scheme, your voice is ignored. They even have all board members agree to never discuss what goes on inside their closed meetings, AND every decision must be openly supported by every board member. I wish I could find a bookie who would take odds on the likelihood that MACRA will be delayed or altered in any substantive way. I might finally be able to retire by mortgaging my house and putting everything on the AMA/Government plan standing pat, despite the preponderance of negative feedback they are receiving. Continue reading
Richard Armstrong, MD of https://d4pcfoundation.org/ submitted the following comments to CMS in opposition to the 962-page MACRA proposed rule. Comments are due 6/27. Submit yours TODAY at http://bit.ly/macracomment
Good afternoon, Ladies and Gentleman,
My name is Dr. Richard Armstrong. I am a general surgeon who has been in practice for 35 years since completing post-graduate training. I have been in the military, in academics, in private practice and now employed. I have watched the development of the federal medical bureaucracy since 1976 and opposed more government intervention then in public in a letter to the Washington post. I did this as an active duty naval officer and received hundreds of letters of support.
In 2009 after President Obama spoke before a joint session of Congress about health care reform, I wrote to him with a simple specific request. I asked him to please speak with the doctors on the front lines, the dedicated physicians and surgeons who care for all of you and your families day and night…24/7. The fellow human beings who are there for you when you need us and who passionately care about our profession and our patients. Of course, my plea went unheeded, so I joined a group of concerned physicians and traveled to Washington to read my letter in public on October 1st, 2009. This was the beginning of a national movement to return the leadership of our proud profession to those who understand what it is to care for individual human beings, one at a time, face to face, with dedication, compassion and excellence. That movement is growing. Continue reading
For Urgent Consideration and Action
This letter is from The National Physician’s Council on Healthcare Policy, or NPCHCP. 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, surgery and government healthcare policy.
The Council has read and critiqued the nine hundred and sixty two pages (962) of Centers for Medicare and Medicaid Services, or 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 “so-called,’ Affordable Care Act,” or ACA, waste billions of taxpayer dollars and violate your rights to privacy, security and choiceif they are allowed to proceed forward.
MACRA/MIPS will destroy your privacy, security and healthcare options, 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 by law to betray the Hippocratic Oath by linking payment to the collection of intimate and private data on all patients, not just Medicare and Medicaid enrollees. All data must be made available without restriction to CMS and related government entities via the electronic medical record, per the regulations, endangering your privacy and security. The government and insurance industry are exempted from HIPAA, the so-called, “privacy statute.” Further, mandatory reporting and participation by physicians and healthcare facilities is to be used for bureaucrats to publically grade physicians on the pretense of quality. MACRA MIPS will not pay for your healthcare office visits to physicians and facilities, but by a complex series of equations based on your personal, formerly private data. The government is free and clear to ration care by choking payment to death for certain procedures, groups or even individuals as they see fit, with no responsibility to the people it is purported to serve.
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. This includes not just Medicare recipients, but all insured persons, whether individual, corporate or government. This law actually extends CMS reporting requirements to individual privately insured, employer sponsored, as well as, government Medicare and Medicaid patients also. 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 policians, IT vendors, hospitals, big pharma 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 taxpaying citizen has an obligation to protect their own self interests of privacy, security and freedom of choice.
We urge you to voice opposition to this government takeover of your privacy, freedom of choice, and healthcare options during the CMS MACRA comment period prior to June 27, 2016. We all can and must do better.
Here is where you may make your comments:
The NPCHCP thanks you for all your help. Let’s take back our rights and freedom NOW.