Screams from MSM about “Slashes to Medicare and Medicaid,” are this week’s #fakenews.

President Trump released his budget proposal today for 2021 through 2030.
And just like last year (and the year before) Democrats and the main stream media are screaming about how he is planning to slash Medicare and Medicaid.

For example:

Newsweek’s headline: MEDICARE, MEDICAID, SOCIAL SECURITY: TRUMP’S PROPOSED BUDGET SLASHES ENTITLEMENTS—AND CAMPAIGN PROMISES

“TRUMP’S NEW BUDGET PROPOSAL SLASHES MEDICAID, MEDICARE,” states Vanity Fair.

Meanwhile, NBC News reports:

Joe Biden, said it “eviscerates Medicare,” while top Senate Democrat Chuck Schumer of New York said Trump is planning to ”rip away health care from millions of Americans” with cuts to Medicare and the Medicaid health program for the poor.

What’s the real story?

Under President Trump’s budget, Medicare spending in 2030 would be almost 200% of 2019 spending while Medicaid would approach 150% of 2019 levels.  How can any rational person describe that as a slashing. Sounds like fake news.

Without any changes by President Trump, interest on the debt in 2030 would be more than double the 2019 payment of $409 billion and would alone eclipse Federal Medicaid spending. Does that sound sustainable?

The real headline should be that President Trump is taking steps towards a desparately needed balanced budget.

Do Not Gloss Over the Devastating Impacts of Policies that Declare Mid-Levels are Equivalent to Physicians

Friend of IP4PI Amy Townsend, MD writes in:

Please do not gloss over the potentially devastating impacts that Section 5 of President Trump’s Executive Order on Medicare will have on our healthcare system.  

I am a board member for Physicians for Patient Protection, a grassroots physician group that promotes physician led care.  We have been actively fighting scope of practice invasion in nearly every state for the last 3 years.  NPs and PAs can be a valuable part of a physician led team but they are not equivalent to physicians in education, training, or ability.  The government permitting them to independently practice medicine through legislation and not education will devastate healthcare.  Here are a few of my concerns:

1.  Patient safety, patient safety, patient safety!!!!

As NPs try to increase their numbers, they have sacrificed the quality of NP education.  They have created degree mills that are churning out 27,000 NPs per year.  Many schools have 100% acceptance and didactics that are 100% online and can be completed in as little as 18 months.  This is followed by a mere 500 hours of shadowing as their “clinical experience”.  Compare this to 16,000 clinical hours for a family medicine physician.  We are seeing and hearing devastating stories of misdiagnosis and mismanagement of these poorly trained practitioners daily.

2.  Medical expertise will be gradually diluted down.  

Why will our best and brightest students even try to conquer to academic rigors and expense of medical school when you can take a cheaper, less time consuming course to practicing medicine independently and have the same reimbursement (due to pay parity proposed here).  As a Family Medicine physician that has been practicing almost 15 years, I value every second of my training.  It is needed for me to be an expert at my craft.  

3.  NPs and to a lesser extent PAs, in general are corporate YES men.  

They have not been taught in their training to take ownership of patients as physicians do.  They do not take the same oath to protect patients at all costs.  If they are declared physician equals and can replace physicians, we will lose all negotiating power with corporate entities, government, and insurance companies.  If physicians stand up for patients, they will simply be replaced by a more agreeable, complacent NP.  
There are probably a million additional reasons.  But it is late and I’m sure you all are tired of reading my rant.  But I am begging you all to please give this issue it’s due respect.  The president has it WRONG on this issue.  We can not continue to have this conversations in the dark corners because we are afraid of liking like we are being mean to nurses.  Our profession, our fellow physicians, and our patients need us to speak up.  

Thank you all for your wonderful advocacy.  I believe it is people like us that can and will fix our broken system. 


Amy Townsend, MD, Family Medicine/Hospital Medicine

Less is More: take the deductions for MACRA non-compliance

Friend of IP4PI, Jane Hughes, MD writes in:

Greetings,

Read this BS sent to us by our “professional” organization whose mission is to preserve the profession, etc etc. For the love of God I cannot understand why any physician can’t see by now that this is a fool’s errand and meant to be. Our clarion call should be to all doctors: Take the deductions for non-compliance because: you will save in essence $40,000/yr in compliance costs that would take $430,000 in Medicare payments at the 9% top reward to equal your $40,000 reimbursement before you see a penny in increased payments. More importantly, you can proudly state that you are saving the government (taxpayers) money at the same time. And the best, wait for it- it would go away because no one would be doing it.

This is not to say I have given up on reform. But, to change Medicare we have to straighten out the private sector, and then, with insolvency looming, we can give Medicare ppl a choice- defined monthly contribution (i.e. check like Social Security) or continued traditional Medicare, which would also be a fast disappearing institution with the current costs to “beneficiaries.” Gee, HSAs with no networks, Medicare as catastrophic, and cash pricing versus what we have now… pipe dream worth fighting for. As you can see I almost came off the rails reading this stuff.

Warm regards,
Jane

More Fed carrots? Or just a different stick? #MACRA #MIPS

Secretary Azar says HHS may cease reporting requirements for MIPS “value-based” care. Perhaps you’re beginning to think that they are finally hearing us, right?

However reading further, things get murky fast:

Instead of requiring physicians who participate in MIPS to submit patient data, the proposal suggests having the government use claims data and patient surveys to grade doctors in the program. “We would be able to independently look at data ourselves to decide their compliance with the quality programs rather than their having to even report anything,” Azar said at Thursday’s hearing.

Here’s what some physicians are saying about this “new direction” from HHS:

  • I’m not going to celebrate just yet. Think of how often HHS/CMS have replaced a bad idea they had, with an even worse idea. If they begin using patient surveys (Press Gainey, etc.) to determine whether or not physicians are given a bonus or penalty, I think that could actually make this awful MIPS experiment even worse.
  • We must be careful what we ask for- and we must control the conversation. There is no reason the government needs to be involved at all – that’s the beautiful thing about the free market – the patient receiving the service determines the value – but the patient must have an  appreciable fiduciary responsibility and they vote with their wallet – good restaurants are busy – bad restaurants are closed – really quite simple.
  • MACRA/MIPS  is fatally flawed.  Patients are individuals and cannot be reduced to an algorithm.
  • There is nothing salvageable or workable in the MIPS system. There is no way on paper and with claims that physician skill, judgement or even outcomes can be legitimately assessed. Further, major institutions are rethinking patient evaluations of physicians, realizing that it is a one way system-i.e. there is no way to evaluate the validity of the patient evaluation and no way for the physician to respond.
    In my opinion our best/only meaningful way of reform is to condemn the entire MACRA/MIPS construct as wasteful and invalid without adding anything to patient care. In fact a point can be made that it detracts from actual care.
  • We should have a say in the type of patient survey they set up. And this should decide only incentives not penalties. The only difference between this and MIPS is that with MIPS we can lose money after spending it on data collection, whereas here we avoid double jeopardy because they do their own data collection and we don’t have to attest to anything. Overall I think what they have suggested is better than MIPS.
  • I just had a very cranky daughter complain about the resident who called her sister rather than her when her mother took a turn for the worst. She would give that resident a failing grade. So much subjectivity makes those evaluation meaningless. Also, when grading a physician on outcomes, which physician can take credit for which specific outcome? Many physicians are often involved. This evaluation scheme is totally unworkable.

I think you’ll agree there is more than a bit of skepticism that CMS is going to meaningfully change things for the better. Tell us what you think!

MACRA MIPS? Time for GACRA GIPS to hold lawmakers accountable.

How can we hold Congress accountable for the failed policy they continue to foist on American patients and doctors?

Meet GACRA GIPS, the Government Accountability Credibility Realignment Assessment and Government Incentive Payment System.

With GACRA GIPS, if congressmen and congresswomen don’t work, vote, complete their tasks and create a budget that lives within our means well paying down the national debt, they don’t get paid.

Learn more about this needed reform in the latest article by IP4PI founder Craig M. Wax, DO published by Medical Economics:

http://medicaleconomics.modernmedicine.com/medical-economics/news/your-voice-physician-accountability-let-s-legislate-congressional-accountability

57 Million Seniors’ Medical Care Imperiled by Medicare Red Tape

Action is needed this weekend! Take advantage of an opportunity to cut through some of the bureaucratic red tape that imperils the medical care of 57 million seniors. Actually, the regulations in question harm not only Medicare patients, but also put “commercially insured patients and their data under the agency’s control,” explains Dr. Kris Held.

CMS is seeking comments from the public on proposed changes to MACRA rules to be implemented in 2018.

Tell CMS to further widen exemptions from MACRA overregulation for physicians and their patients.

Comments are due by 11:59pm Eastern Daylight Time, Monday, August 21, and can be submitted online at the following link:

https://www.regulations.gov/comment?D=CMS-2017-0082-0002

Here’s an example of what you might say:

MACRA compliance is not compatible with patient-centered medical care. CMS must use all possible discretion authorized under law to free as many physicians as possible, and their patients, from this harmful overregulation. At the very least, practices with 15 physicians or fewer should be exempt from all MACRA penalties.

Additional details:

The U.S. Centers for Medicare & Medicaid Services (CMS) has released proposed changes to its so-called “Quality Payment Program” (QPP) rules for 2018. The QPP “implements provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) related to the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).”

While initially created under the guise of increasing “quality” and “value,” in practice the program attempts to coerce doctors to comply with cookbook medicine and government rationing protocols while at the same time compromising patient privacy.

Fortunately, there are some new faces at CMS who understand the danger of this program and a few helpful changes have been proposed; however the changes don’t go nearly far enough. We are asking CMS to use all possible authority to lessen the burden on patients and physicians.

AAPS is not alone in calling for these needed changes. The Editorial Director of Medical Economics has called on CMS to “Exempt all small practices from the program. … Smaller practices shouldn’t have to play the same game as the larger practices they already compete against every single day when it comes to things like patients, resources and payer influence. Don’t make the alleged ‘failures’ of small practices fund larger practice payment bonuses.”

Please submit your comments to CMS on this crucial issue before the Monday deadline.

Thank you for your help!

~AAPS

For the full proposed rule see:

https://www.regulations.gov/document?D=CMS-2017-0082-0002

And the CMS fact sheet on the changes is available at:

https://qpp.cms.gov/docs/QPP_Proposed_Rule_for_QPP_Year_2.pdf

MIPS Math: a losing equation for physicians and patients

Dr. Jane L. Hughes reacts to the latest offer for MIPS “training”: http://conta.cc/2ps7YTq

I will bet that in their course they will not mention that “the physician must [participate in MIPS]” is not true. The physician chooses to comply in the hope of getting that 9% increase in Medicare payment. CMS says 47% of physicians will lose the zero sum game of MIPS. Weill Cornel Medical college estimates the cost of compliance with EMR, PQRS, etc to be $40,000/physician/year. As I’ve said before, do the math. You would have to clear $430,000 at a 9% return (if you are in the elite compliers) to reimburse yourself for your compliance costs. Hey, then you’d be rolling in reward money…What a thinly veiled process to gather the data to justify real time treatment dictates. I know of no other profession that would give up their privileged communication without a tooth and nail, knock down drag out fight, except the medical profession. If only because of the disastrous treatment implications of not being able to candidly talk and privately record medical and surgical encounters, it would seem to me that all physicians, in spite of the many compliance courses, should choose to just say no, at least to “interoperable EMR with 24/7 unfettered access” by HHS and CMS, as dictated in the MACRA law.

Best regards,

Jane