MACRA = The Destruction of Medicare and Those Practices That Attempt to Comply


Here are my thoughts on reading my section of the “final” rules. If anything is apparent it is that there is no such thing as final rules, and in fact everything in the section I read was prefaced with disclaimers. I would like to entitle my section as, “The Destruction of Medicare and Those Practices That Attempt to Comply.”

This publication of the finals rules is almost of zero value to any physician or any patient, and in fact is a gobbly-gook of acronyms that hardly make sense and make the reading of the rules almost impossible without constant reference to their senseless definitions. There is nothing remotely suggestive of the actual practice of medicine. For example, CMS regards radiologists and pathologists as “non-patient facing MIPS eligible physicians.” One is struck with every rule and condition with the obvious question-how many bureaucrats at what expense would be required to track, collate, evaluate, and determine payment on over 800,000 physicians with this unwieldy payment system disguised as “quality not quantity” rewards.

Reading the four pages of acronym definitions alone reveals why this will not work. They are literally beyond belief, like “CDS” which is “Clinical Decision Support”… Cookbook medicine anyone? These read like pages from “Brave New World” but unfortunately they are not fiction. This is the groundwork for population based medicine which is further supported by the TCPI which is “Transforming Clinical Practice Initiative,”- by government fiat using measly payment rewards as the carrot. Considering Congress did not read MACRA before it was passed, the last sentence after all of the definitions is emblematic of the arrogance of this agency. “The MACRA, landmark bipartisan legislation, advances a forward looking, coordinated framework for health care providers to successfully take part in the CMS Quality Payment.” To set the record straight, we are physicians, not health care providers. We render care to our patients by screening them for disease, collaborating with them regarding health related issues, and intervening in medical and surgical episodes. We expect and deserve to get paid, not “successfully take part in the CMS Quality Payment” system, which takes over a thousand pages to define. Furthermore, clearly 50% of physicians will not be “successful”, as the MIPS reward system is a zero sum game. For every physician reward, another physician gets a deduction.

Throughout my section, in response to comments, their response seems to be if CMS says it, it is valid and applicable. However, it can be seen throughout their comments that this is an experiment in progress. They admit that the proposed rules for cost performance category have never been used for payment purposes, and CMS may choose to specify a subset of these measures. Since doctors prescribe drugs, CMS thinks they are the drivers of drug costs, so drug prescription costs will be included in each doctor’s cost coefficients. This of course places the physician in an ethically untenable position. Do CMS bureaucrats own this Medicare money? On page 599, read this statement and ask yourself what it means: “As noted earlier, we have provided performance information on episode-based measures to MIPS eligible physicians through Quality and Cost Reports.” How does CMS determine quality? How does CMS determine performance? Everything upon which they are basing their assumptions is in actuality based on Medicare claims forms and their mostly failed “Accountable Care Organization” pilot projects to gather “episode of care” data. The truth is they cannot judge quality or performance, only cost. This is deceitful propaganda.

I quit my reading page 621 with this statement: “Section 1848 (q)(2)(C)(v)(III) of the act defines an improvement activity as an activity that relevant eligible clinician organizations, and other relevant stakeholders identifies as improving clinical practice or care delivery, and the the Secretary determines, when effectively executed, is likely to result in improved outcomes.” The Secretary is not a physician. The Affordable Care ACT, the most costly and destructive major piece of legislation in recent history, was sold to the American people by politicians and bureaucrats. Real practicing physicians from across the country who read the ACA, warned that Obamacare was not doable, and that it would cost billions of dollars and send our healthcare system into chaos before it failed. Now, we see that MACRA is Obamacare on steroids. It is statism command and control by bureaucrats that do not understand the system.In fact, they have commandeered Medicare funds to dispense at their behest. The only choice for physicians is to not participate in any of the payment reward or reporting rubrics. Take the fines, and if if compliance becomes mandatory because too few physicians will participate in their payment scheme, doctors will have to drop out because compliance is a fool’s errand, and a bankrupting one at that.

Best regards,

Jane Lindell Hughes, MD
Co-founder of
Office: 210-614-5566
Twitter: @janehughesmd

2 thoughts on “MACRA = The Destruction of Medicare and Those Practices That Attempt to Comply

  1. Pingback: MACRA = The Destruction of Medicare and Those Practices That Attempt to Comply | drginareghetti

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