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

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.

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:
Whole MACRA here:
Best wishes for good health,

Craig M. Wax, DO
Family Physician
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax

Physicians must take back control over definition of quality in medicine

Guest Post by Cynthia Marcotte Stamer, Esq.

Balanced billing is an important element, but only works if physicians recapture control over the quality question.   That’s why in addition to anything else physicians do, physicians must work to take back control over the right to define quality in medicine by controlling or beating back payer driven, cost motivated PQRS and other quality rankings that demonize physicians for practicing better medicine than what payers want to pay for both by demanding meaningful input to the design and quality standards and processes, pushing for reform that prevents payers and the government from misaligning and punishing physicians that put patients first, and other actions that ensure that patients put their confidence and control of care in the hands of physicians not payers or the government.   CMS recently extended the comment deadline on the 2016 PRQS Quality Measure Plan to March 1.  See CMS Seeks Public Comments on Draft Quality Measure Development Plan (MDP) by March 1, 2016 (1-29-2016). See here.  I urge everyone to review and submit meaningful comments on these proposed quality measures as whether or not you use to participate, they will be used to rate you. Continue reading

Ayn Rand’s speech against socialized medicine in 1963; 100% relevance today.

https://ari.aynrand.org/issues/government-and-business/health-care/How-not-to-fight-socialized-medicine

ICD 10: anticipated and unanticipated consequences of government mandate

ICD 10: anticipated an unanticipated consequences of government mandate

Craig M. Wax DO

October 1, 2015 ICD 10 was mandated by the US federal government department of health and human services (HHS). Their stated goal was to improve data collection and research but the consequences, both anticipated and unanticipated, are becoming clear. 

Even before day one of implementation, it has been costly in time, money, and work that needed to be redone. Laboratories and other testing facilities call constantly for new codes in ICD 10 before they will do testing on patients, even though the codes are for billing, insurance, and government bureaucracy purposes only. Patients are being turned away from labs and radiology facilities. 

Patient history and examination time is now squandered due to electronic health records EHR and chasing new ICD 10 codes. Insurance companies have required “referrals” since about 2000. Originally, referrals meant when a doctor recommends another doctor or facility and gave them an RX script to use that service. Initially, referrals become a paperwork game where a form was filled out for insurance to recognize the service. The insurance companies even said that the referral wasn’t even a guarantee of payment, so what was it for? Since, it has become an electronic online process with an Internet company owned by insurance companies called Navinet. Now, our staffs have to enter all the referring information and diagnosis codes in order for the insurance process to even begin or the patient be scheduled for the test at all. Now with ICD 10, the systems are not recognizing the codes and not allowing these insurance mandated processes that waste our time to even carry to completion so a patient can get the study they need.

Due to all these exogenous process mandates, patient care suffers. Less patient physician contact time is possible in the exam rooms. Physicians, and their staff, are designated data gatherers for insurance and government whims. Time and money are wasted by all parties that are gathering the mandated data. The data will be aggregated by government and pirated, patients extorted, and data lost, with no party responsible except for the physicians who entered it. Patients get frustrated because care is denied due to insurance not reimbursing for procedures due to flawed, complicated processes mandated by the insurance industry. All individual patients’ and physicians’ privacy, security, and care is lost. 

This is yet another government, and their industrial cronies, scheme to command the data and make money for themselves, while patients go without care and physicians suffer the unanticipated consequences. The medical community and its physicians must stop abiding by all the nonsense and get back to patient care with direct primary care; putting the patient first and responsible for their care. 

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 Basic Billing Code Sheet

I spent the last few weeks converting my old billing sheet to ICD-10 with as much specificity as possible. I’m sharing it with hopes it will be helpful to others caught in this new bureaucratic red tape. These codes were converted using the free application ICD10charts.com.*

Download ICD-10 Primary Care Billing Sheet by System: Excel File | PDF File

*This information is offered for general information purposes only and is not intended to solve all billing problems. The codes are not guaranteed in any way, shape, or form.  Good luck! ~Craig M. Wax, D.O.

CMS Medicare PQRS is Fatally Flawed

The PQRS CMS Medicare program is fatally flawed. Any program that is run by third parties, insurance companies or big government cannot possibly take into account all the necessary variables and patient value systems that exist. Physicians are held to that gold standard, while the other parties are held to no standard at all.

Patients deserve a time-honored, unique, private relationship with their physician that values their individual value system and is unfettered by government, insurance and other third party entities.

Craig M. Wax DO