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

A Conversation: Can Free Markets Save American Medicine?

A recent article from the Mises Institute. “Under Socialized Medicine, The State Owns You,” sparked a conversation between Mr. Bob Wells and IP4PI founder Dr. Craig M. Wax.

Bob

I appreciate your assessment of the solutions presented like VA, Medicare and Medicaid being awkward, too expensive, and failing in large demonstrable ways. We haven’t had true market based medicine since World War II. Prior to that, it was relatively inexpensive cash and Barter based services. I argue this is the most efficient as it cuts out insurance, pharmacy benefits managers, all levels of administration, and last but not least, all aspects of government regulation compliance and taxation.

In the last six years there have been at least 12 plans on the table to repeal Obamacare. And, there have been six in the last 12 months. There was no sparsity of plans, just no palpable consensus.

I assert that inexpensive primary care, labs, low-end studies, cheap generic medications, will allow for most needs to be met by most people. And expanded health savings account HSA would be used for each citizen to use pretax dollars to buy anything health related from gym memberships to over the counter medications to actual care necessities. Further, inexpensive catastrophic insurance for the big ticket items would be also affordable by most. There could be community, charity, and state programs to provide for the neediest, while keeping the federal government taxation hands to itself.

Unless the Congress and President act soon to repeal Obamacare, just rearranging the deck chairs, will not prevent its fate. Already 19 out of 23 taxpayer-funded co-ops have gone bankrupt taking billions of taxpayer dollars with it. And for the phony federal mandates state exchanges, many have only one high price insurer participating, while still others have none. Leave it to the government to mandate you buy something very expensive and then there’s no opportunity to even comply!

Best wishes for good health,
Craig M. Wax, DO

—————

Dr. Wax,

The deficiencies of state-sponsored health care are widely known. What is difficult to figure out is an alternative — market-based — that is universally accessible and affordable (with affordability being as elastic as elastic can be), while still offering high quality. If there is a model in this world, I am unaware of it.

All efforts America has made to provide public support for health care since World War II, from the VA system to Medicare and Medicaid to Obamacare, have been awkward and grossly inefficient (if somewhat effective, overall). Unfortunately, blowing these systems up and starting a new system based solely on market forces would be catastrophic in the short term. And since politicians think in the short term, such a radical transformation is impossible.

Today’s Republicans realize there is reward in trashing Obamacare, but they also know that they do not have a better plan to replace it. If they really had a better plan they would have introduced it by now, and it would be on President Donald Trump’s desk for signature. The fact that they cannot agree among themselves on a replacement is testimony to how difficult a problem this is. (This does not excuse the Democrats, either.  They’d rather let the Republicans look foolish than offer their own “solutions.”)

Regards,

Bob Wells

Valueless layers of bureaucrats crushing patients and doctors: it’s time to just bust out

Friend of IP4PI, Jack Iannantuono, writes in:

By taking over medicine in 1965 with Medicare the government had sown the seeds for the blood sucking, valueless layers of bureaucrats and regulations and Wall Street greedy hand and malpractice windfall in highway lining billboards with pictures of Physicians you will never see in person that now accounts for nearly 20 % of GDP about $3.3 trillion and I tell you truly health care can be delivered for less than a third of that…yes less than 1 trillion and be less than 5% of GDP and our physicians and communities would do it if we can just bust out of Washington trying to fix, reform or replace.

There is no need whatsoever for government to have a say or a place in medicine.

Obamacare turned from a nightmare into a weapon. Dang it …can we learn from this?

Jack Iannantuono, CFP®, ChFC®, MSFS, AIF® | Indicon, Inc.
Chief Executive Officer

Who does “Organized Medicine” work for?  Follow. The. Money.

With a significant portion of their physician constituency opposing the misnamed Affordable Care Act, i.e. Obamacare, and set to be harmed by bureaucracy-laden MACRA regulations why are some of the biggest names in “organized medicine” out in front cheering on these harmful programs?

Follow. The. Money.

The American College of Physicians has received about $3.5 Million in taxpayer funds from the federal government since 2011:
https://www.usaspending.gov/Pages/AdvancedSearch.aspx?sub=y&ST=C,G,L,O&FY=2016,2015,2014,2013,2012,2011&A=0&SS=USA&RN=American%20College%20of%20Physicians

The AMA $5.4 Million (not including CPT royalties):
https://www.usaspending.gov/Pages/AdvancedSearch.aspx?sub=y&ST=C,G,L,O&FY=2016,2015,2014,2012,2011&A=0&SS=USA&RN=american%20medical%20association

And this is “chump change,” explains Dr. Meg Edison, compared to the $86 Million taxpayer dollars the American Academy of Pediatrics raked in. “No wonder they were hashtagging the heck out of #VoteKids at election time. It’s a big business.”
https://www.usaspending.gov/Pages/AdvancedSearch.aspx?sub=y&ST=C,G,L,O&FY=2016,2015,2014,2013,2012,2011&A=0&SS=USA&RN=American%20academy%20of%20pediatrics

Bob Doherty, Exec. Dir. of ACP retorts that the taxpayer dollars “to help docs improve quality isn’t a COI but core to ‘ mission to promote excellence in medicine.”

“Helping docs improve quality” is apparently a euphemism for training physicians to comply with the crushing burdens of ACA and MACRA, a program passed in the name of “quality” but which ultimately punishes physicians for practicing individualized patient care, instead of cook book medicine as defined by CMS policy-wonks.

A sizable chunk of the funds flowing to ACP is ACA-driven funding “to help health providers achieve large-scale transformation” and “ensure sustainability” of these efforts.

With these large sums of money flowing into the coffers of those supposedly representing America’s physicians and their patients, it’s past time for hard questions to be asked and answered. Whose interests is “organized medicine” really looking out for? A hint: it’s not physicians or patients…

Don’t Ignore the Lessons of History: MACRA will simply not work

The following MACRA comments were written by a Kansas City dermatologist, Viseslav Tonkovic-Capin, MD, who grew up under Communism in Czechoslovakia.

I was born and raised in communist Yugoslavia. My dad was a 9 year-old boy when WWII started and was courier for partisans, i.e. resistance against nazis and fascists during the war. After the war it was easy to dupe people into communism, because as an idea it sounded great, but within a several months or years almost everyone realized that it simply will not work.

My dad became lawyer and judge just to end up in the political prison because of his disagreements with the communist interference into his judicial duties. In short order my entire family turned from communists and communist sympathizers into people severely allergic to anything resembling communism.

My dad summarized the difference between communism and the Free World: Continue reading

Trump calls a congressman physician to lead real patient-centered reform at HHS

IP4PI joins patients and physicians across the United States in cheering the appointment of Congressman and orthopedic surgeon Tom Price, MD to head the Department of Health and Human Services in the incoming Trump administration.

Dr. Price has a long history of standing up for the patient-physician relationship against the myriad forces seeking to intervene to the detriment of quality patient care.  And indeed, proponents of top-down government control are quickly sounding the alarm  realizing they have an enemy in the congressman & good doctor from Georgia.

We look forward to supporting Dr. Price in his efforts to roll back ObamaCare, MACRA, MU and many other failed policies harmful to American medicine. Proven patient-centered solutions can then be unleashed to increase access to high-quality, low-cost medical care.

Congratulation’s Dr. Price on this well-deserved new job!  We are here to help you in this crucial and challenging work over the coming years.  The future of American patients and physicians will depend on it.

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

Greetings,

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. Continue reading