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