Promoting Choice and Competition to Empower Patients and their Physicians

A friend of IP4PI writes in:
I just read President Trump’s executive order on choice and competition across state lines. It has these amazing provisions which have not been discussed in the media at all!! These provisions go to the heart of a competitive market-based healthcare system.
“(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system. To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should:
(i) expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs;
(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power; and
(iii) improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes, while minimizing reporting burdens on affected plans, providers, or payers.”
The whole order can be read here: https://www.whitehouse.gov/the-press-office/2017/10/12/presidential-executive-order-promoting-healthcare-choice-and-competition . I love the title to promote choice and competition.  I don’t think the order was overreach, because the language is to ” PRIORITIZE three areas for improvement in the near term: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).” and “FOCUS on promoting competition in healthcare markets and limiting excessive consolidation “.  I did note this part:” Public Comment. The Secretaries shall consider and evaluate public comments on any regulations proposed under sections 2 through 4 of this order.”
Stay tuned for opportunities to comment!
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CMS wants your comments on market-based Healthcare innovation. Deadline Nov. 20.

CMS has caused quite a stir this week by announcing they are shaking up their CMMI “Innovations” office.
They are looking for input on “Consumer-Directed Care & Market-Based Innovation Models”  that might be beneficial to Medicare and Medicaid patients.
“What options might exist beyond FFS and MA for paying for care delivery that incorporate price sensitivity and a consumer driven or directed focus and might be tested as a model and alternative to FFS and MA?”
Here’s a link to the full request:
The deadline for submitting comments is November 20 and the link to their webpage on this is here:
And the response form is here https://survey.max.gov/429625

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

Tell CMS to Protect Patients and Physicians from Harmful Red Tape

CMS has released the proposed 2018 regulations for MACRA and is asking for comments.  The new changes don’t go far enough to protect independent physicians and their patients from harmful red tape.

CMS has a fact sheet about the proposed rule available here:

Comments are dues August 21 and can be submitted here:
https://www.regulations.gov/document?D=CMS-2017-0082-0002

Dr. Marcy Zwelling had put together sample comments to help everyone get the correct message to CMS.

Below are comments that you can cut and paste –

Medicare Administrators: 

We appreciate the sentiment of the new MIPS regulations, but it does not get the job done for many physicians struggling to go to work and NOT sit behind a computer all day. America’s physicians need to be able to just do our job and struggling with computers does not help us get it done.  It is not about micro-managing the regulations; it’s about our professionalism. 

We understand the statutory constraints, and we think we have the answer.  If the regulations could be edited to read 

Exemptions permitted:

Clinicians below the low-volume threshold – Medicare Part B allowed charges per physician less than or equal to $90,000 OR 200 or fewer Medicare Part B patients per physician up to a 6 person practice. 

Thank you for your serious consideration.  While this change does not save all small practices, we feel that this minor change will send the right message to American physicians and will encourage physicians to work with CMS and keep their offices open. 

 Further, we encourage CMS to follow thru with Dr. Price’s commitment to allow physicians to balance bill as a means of enhancing our patients’ options and keeping physicians’ doors open. 

Yet another failing report card for the “Affordable” Care Act

CMS released a county-level map of 2018 projected ACA Exchanges participation:

“This map shows that insurance options on the Exchanges continue to disappear.  Plan options are down from last year and, in some areas, Americans will have no coverage options on the Exchanges, based on the current data.”

“This is yet another failing report card for the Exchanges. The American people have fewer insurance choices and in some counties no choice at all. CMS is working with state departments of insurance and issuers to find ways to provide relief and help restore access to healthcare plans, but our actions are by no means a long-term solution to the problems we’re seeing with the Insurance Exchanges,” explains CMS Administrator Seema Verma.

Plans proposed to Repeal/Replace or Amend ACA

Congressman Tom Price’s plan

http://www.washingtonexaminer.com/prices-obamacare-replacement-would-shift-power-to-patients-which-is-why-special-interests-will-hate-it/article/2609165?custom_click=rss

Speaker Paul Ryan: A better way

http://abetterway.speaker.gov/

Congressman Sessions/Cassidy plan

http://www.goodmaninstitute.org/topics/health-reform-bill/

(Former Congressman) Dr. Paul Broun plan

http://www.paulbroun.com/issues/health-care

Brat/Flake “HSA Expansion Act” would eliminate the “mandate” that HSA holders purchase a government-designed high-deductible health plan. “As a replacement for ObamaCare, Large HSAs would encourage innovative products like pre-existing conditions insurance that make coverage more affordable and secure.”

http://www.forbes.com/sites/michaelcannon/2016/06/02/five-things-you-need-to-know-about-the-bicameral-legislation-creating-large-hsas

Ideals and principles

National physicians’ coalition for freedom in medicine 2015

https://drive.google.com/file/d/0B6mnHrSAs12lUHhzS0ctMHFVRG1pMXZhZFVkbnFwWDVhNzNV/view

IP4PI to CMS: Exempt Independent physicians from ACA MACRA MIPS and APMs

CMS ACA MACRA MIPS and APMs discriminate against independent solo and small primary care practices, while unfairly advantaging hospital health systems who employ doctors. Please exempt solo and small physician practices of 9 or fewer doctors or less than 999 Medicare patients. CMS ACA MACRA MIPS and APMs will put small independent practices out of business and will deprive patients of their physician, jeopardizing their health.

Submit your comments at:

https://www.regulations.gov/comment?D=CMS-2016-0060-3944