Urgent Letter to ALL Physicians: Take Action to STOP MACRA MIPS Rules


Please read the following letter on MACRA MIPS current rulemaking pending with CMS. The report is the unanimous result of a comprehensive review by the National Physicians Council on Healthcare Policy. NPCHCP.org

Consider taking action to formally comment on and prevent the MACRA MIPS rules from taking effect as they would damage the patient physician relationship and would drown care in the red tape of private personal data collection, data manipulation and care reimbursement denials for years to come. Please distribute it to all members for each individual physician to consider action.

All physicians must take a stand to resist giving of the federal government, all insurance companies, and their designees unfettered access to all patient and physician private privileged information.

May 15, 2016

For Urgent Consideration

This letter is from The National Physician’s Council on Healthcare Policy. We are a national organization comprised of physicians from many different specialties from a majority of states. In 2009 the Council was established by members of the US Congress for the purpose of gathering practicing physician’s input on issues relating to medicine and surgery.

The Council has read and critiqued the nine hundred and sixty two pages (962) of CMS Rules spawned from the MACRA Law. By unanimous opinion, even if the stated goals were laudable, the MACRA Rules as written are impossible to implement and will, like the ACA, waste billions of taxpayer dollars and practice man-hours if they are allowed to proceed forward.

MACRA/MIPS will destroy the practice of medicine, taking out the solo and small groups first as physicians buckle under MACRA’s financial burden and become salaried employees or leave practice. Implementation will force physicians to betray the Hippocratic Oath by linking payment to the collection of intimate and private data on all patients. (made available without restriction to CMS and related government entities via the electronic medical record – per the regulations ). In effect, it is restraint of trade and a means to redistribute dollars from the small group practice to the large group practice.  Most importantly, it is not a legitimate means of providing the highest quality of care that our patients deserve and ironically it will not cut costs.

Further, mandatory reporting and participation in shifting government domains is to be used for bureaucrats to publically grade physicians on the pretense of quality. These misleading quality parameters will be used to qualify for financial reward or punishment. One such domain is forced participation in alternative payment models such as Accountable Care Organizations, which are revamped capitated national HMO’s. Even the Medicare pilot projects saw more than half of the participants drop out or fail to save money. References from the Rules are available for the above statements.

In 1965, Medicare was passed with the distinct caveat that the law would in no way interfere with  the practice of medicine and surgery. In contrast, the MACRA law allows total government intrusion into every aspect of the practice of medicine, including unfettered access to every person’s personal health data. Theoretically the data gathered would be used to construct “population based healthcare” rubrics, and finally “Quality Adjusted Life Years (QALY)” to decide who is to receive what care. This law actually extends CMS reporting requirements to non- government privately insured patients. This will most certainly be challenged in court.

The frequent justification for government interference is that the current healthcare expenditures cannot be sustained. Under the auspices of enhancing quality, fixing a flawed payment system, and controlling costs Congress passed another healthcare law few had read. Ironically, the MACRA solution adds billions of dollars in IT, administrative, and software costs to physicians and the taxpayers. At the same time the law takes physicians away from the care of patients. The only winners are IT vendors, hospitals, and entities selling compliance courses and software. With strong opposition, we can stop MACRA during this CMS Rules Comment Period.

The WSJ on May 7, 2016 reported that Washington rules now impose $1.9 trillion of annual costs to the US economy, or $15,000 per household. Smaller business is the hardest hit. It is our opinion that every professional medical and surgical society has an obligation to its membership to protect the interests of its members and promote loyalty to professional ethics and moral sensibilities.

We urge you to voice opposition to this government takeover of our profession during the CMS MACRA comment period prior to June 27, 2016. We can and must do better. Our patients are counting on us.

 The National Physician’s Council on Healthcare Policy is asking CMS to exempt small physician practices of 15 or fewer physicians (CMS definition) from this legislation. If you agree, please include that in your comments.

Here is where you may make your comments. https://www.regulations.gov/#!submitComment;D=CMS-2016-0060-0068

The NPCHP thanks you for all your help.   Let’s take back our profession NOW.

You may email us at: admin@NPCHCP.org
You may call us at: 562-900-2652
You may send us slow mail at: PO Box 2225 Los Alamitos, CA 90720
Visit our website at: http://npchcp.org/

Escape MACRA with Direct Patient Care

Guest Post from Tom LaGrelius, MD – President, ACPP, http://www.acpp.md

A year ago in April, 2015 Congress passed and the President signed the repeal of the SGR formula doctors have lived with for decades. SGR was never really enforced however, since each year Congress passed temporary delays in its implementation and kicked the can down the road. Medicare participating doctors did not usually get any rate increases, but at least the draconian rate cuts the SGR would have mandated were usually blocked. The permanent repeal of SGR was hailed by many as a great advance since it directed CMS to devise ways for doctors to get paid not by the visit, but by our results. However, it still mandated that the new procedures be “budget neutral”, so there will have to be as many losers as winners. If patients were kept well and out of the hospital where the huge costs reside, doctors were to be paid more and paid less if not.

The new law is called the Medicare Access and CHIP Reauthorization Act (MACRA). If you want to read the law, it is not that long, here it is: https://www.congress.gov/bill/114th-congress/house-bill/2/text Enjoy.

Trouble is there are lots of ways to implement such a plan. With Obama’s CMS troops in charge of writing the new rules, the expected happened. CMS has written a 960 page rule, many times longer than the Act itself, that nobody likes. It will force doctors into large groups and ACOs because small organizations cannot possibly comply with its complex reporting regulations. It will kill insurance and Medicare payment based solo and small group practice which will be totally unable to comply and will lose 9% of its revenue for failing to do so. Such practices are already running on very narrow margins with 70% plus overheads and a 9% cut will put many of them out of business and force the rest into contractural arrangements with hospitals that protect them at the price of dictating what they do.

The real irony is that clearly, solo and small group practice are the practices that are currently doing the best job of keeping people out of the hospital and out of emergency rooms. Why on earth would Obama’s CMS what to kill them. (In fact, they should be exempted from this law, and efforts are underway to make that exemption reality.)

The shortage of doctors will increase as more retire prematurely. As others take salaried jobs production and access will drop further since such employment arrangements always result in doctors behaving like employees rather than entrepreneurs, with a predictable loss of productivity.

There is a third option. Solo and small group doctors can do what we have done and form direct financial relationships with their patients in concierge practice and other forms of direct practice so the drastic cuts coming in the next few years will not affect them. Already the Affordable Care Act (Obamacare) has resulted in a massive increase in concierge and direct practice conversions, and that trend will accelerate.

Employees of large companies are now actively looking for concierge and direct practice access arranged by their employers, because in this brave new world since the passage of the ACA and now MACRA their deductibles and co-pays have soared so high that they might as well not have insurance at all. Furthermore, when they try to make an appointment with a physician there are higher and higher barriers to access delaying care, which essentially amounts to denied care. So, the emergency room has become the default location of care for millions. However, investing in membership in a concierge or direct practice once again gives them immediate and affordable access to care.

ACPP should be the organization that helps these new concierge and DP doctors improve and refine their practices, give them a voice in state and federal government, and provide them with a network of like minded physicians with whom to collaborate.

So, we hope to see all of you in September at our second annual ACPP meeting September 24-25 in Las Vegas. It will be a fabulous meeting with amazing speakers and networking opportunities. I hope to see you there.

Thomas W. LaGrelius, MD, FAAFP
President, ACPP

MACRA does not measure physician quality nor improve patient care

Dr. Jane Hughes writes in with a summary of pages 100-200 of CMS’ proposed rules to implement MIPS & APMs.  

Submit your comments to CMS before June 27!: https://www.regulations.gov/#!submitComment;D=CMS-2016-0060-0068

Here are the most telling and salient points for pages 100-200.

  • All reporting has to go through EMR/Questionaires CMS approves
  • The requirements are going to increase for reporting outcome measures over next several years as more outcome measures become available
  • High priority measures to be rated are a. Outcome b. Appropriate use (not defined nor not specified who decides “appropriate use”) c.Patient safety d. Patient experience e. Care coordination quality measures
  • CMS believes MIPS “Appropriate use will minimize overuse of services, treatments or related ancillary testing that may promote overuse of services and treatments.”
  • CMS decides “underuse” of specific services that reflect “overuse” of alternate treatments that are not evidenced based or supported by clinical guidelines. CMS assures that they will seek input from various “stakeholders” as to evidenced based treatments and clinical care guidelines.
  • CMS plans to develop a.Care episode groups b. Patient condition groups c. Patient relationship groups with codes for all.
  • CMS plans to update definition of primary care services, and thinks MIPS survey will closely align with PQRS, but they state they do not know yet.
  • Doctors will bear the cost of contracting with CMS approved survey vendors to administrate the required MIPS surveys.
  • In future years there will be bonus points, girls and boys, for patient experience reports. CMS may expand patient experience measures to all payers so that everyone can be be included.
  • CMS expands reporting to non-Medicare patients to “ensure completeness” for the broadest group of patients possible. If submitting via qualified registries or EMR must report on 90% of patients. If using Medicare Claims must report on 80% patients. KEY: CMS thinks this gives a more complete picture of each MIPS eligible clinician’s scope of practice and more access to data not currently captured on PQRS.
  • CMS plans on increasing data requirements in the future.
  • Global population based measures and global outcome measures may be used by the Secretary for purposes of defining quality performance. Will use Agency for Healthcare Research and Quality (AHRQ) and Prevention Quality Indicators (PQI)in calculating total MIPS score.
  • Secretary will publish annual list of quality measures which may change from the previous year. If performance on a measure becomes so high that meaningful improvement is not possible, it will be eliminated.
  • There’s more of the same, with promises of even more rules to come.

Continue reading

Just as we warned in 2009, the news is not good: Beware ObamaCare II, aka MACRA.

Jane Hughes, MD writes in:

After wasting billion of dollars on failed ObamaCare exchanges and forcing many Americans off their insurance plans, Washington directed it’s attention to fixing Medicare. Unfortunately, the same people who orchestrated ObamaCare authored the MACRA Law, referred to as the “Doc Fix”.

Nine hundred and sixty-two pages of CMS rules were just released, and groups of physicians from across the country have now had a chance to see what’s in it. Just as we warned in 2009, the news is not good. It shifts money for patient care to data mining patient records, destroying privacy and dignity of patients, forcing doctors through payment manipulations to violate their Hippocratic Oath, and paves the way to a bureaucrat rather than your physician deciding your healthcare options. Of course all this is sold as cost control and quality enhancement. If only. MACRA implementation would be astronomically expensive, ever changing and convoluted, and would destroy individual and small group practices as we watch it implode after billions more wasted healthcare dollars.

There’s still time to stop it.

Register your protest. Visit https://www.regulations.gov/#!docketDetail;D=CMS-2016-0060 and scroll down to “Comment Now” button.

Let your Representative and Senator know MACRA must be stopped. Sometimes it’s better to cut your losses.

Tell CMS #MACRA #MIPS is bad 4 both patients & physicians

Dear AOA leadership,

Below you’ll find for links on MACRA MIPS, the latest price-fixing and medical practice control mechanism from The President and congress via CMS. If you’ve read the legislation, you’ll find that all solo and small private practices will be eliminated over the next few years, and eventually even the larger practices will follow because of “negative payment adjustments.”

Please act immediately to exclude all practices under 10 physicians, with 10,000 Medicare patients, billing less than $1 million a year. The current exclusion is 100 Medicare patients and $10,000 a year. Further, we need to get government entities out of the practice of medicine. Furthermore, the AOA must make a plan and take steps to take back the practice of osteopathic medicine from third-party “stakeholders” as well.

#MACRA #MIPS is bad 4 both patients & physicians

#CMS slides https://innovation.cms.gov/resources/macra-intro2.html

MACRA regulations out ensuring demise of private practice

MACRA MIPS legislation

To submit a comment to CMS visit https://www.regulations.gov/#!docketDetail;D=CMS-2016-0060 and scroll down to “Comment Now” button.

Must comment by 06/27/16

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.
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

We need to stop looking to politicians

Richard Armstrong, MD shares his thoughts on what physicians must do following the King vs. Burwell ruling by the Supreme Court of the United States:

The government is on a fantasy fiscal trajectory and they have been for 5 decades. MACRA accelerated it, but it allowed Congress to wash their hands of the issues for about another decade. This SCOTUS decision simply says that the government can “allocate” about another $700 billion to subsidize health care spending over the next decade…roughly.

Since 1990 the percentage of GDP allocated to all federal spending has remained relatively constant. However, in 1990 1/3 of that spending was on “entitlement” programs. By 2015 the percentage has increased to ½. The projection is that by 2030 the percentage will be 2/3. Spending on entitlements will crowd out everything else. Continue reading

LEAD BY EXAMPLE, not by words or emails!

Dr. Steven Horvitz – writes in

I am getting tired of all the bitching and moaning, yet everyone still continues to bend over and get sodomized day in and day out by third parties, government regulations and even worse our own physician societies.

Words, words and more words and yet it only gets worse.

Our patients think we are crying wolf because what actions have we taken to prove we mean what we say?

If you do not act, just forget about it and be assimilated.

Possible actions:

1- Opt out of all insurers. Don’t play their game.

2- Resign from the physician societies that have been screwing you.

3- Get a position in the societies and change them.

4- Start our own physician organizations and bring other docs fed up with the system over to ours. Strength in numbers only if walking the walk!!

5- Retire. I hear WalMart is hiring greeters again.

6- Run for political office and then DO NOT get altered by the system. Politicians think they are the system. Unless we fight back they will continue to think that way.

7- Treat every one of your patients like they were your family and get their support for any and all of the above that you have changed.

Other than that keep just sending emails and keep digging your own grave.

Nobody likes complainers. Our patients will not follow complainers, but they will follow and support leaders.

LEAD BY EXAMPLE, not by words or emails!

Steven Horvitz DO

Thirteen Steps to Save American Medicine – Time Is Short!

Via Dr. Parvez Dara:

  1. Time Is Short!
  2. Opt out CMS & MOC
  3. Simultaneously educate our patients
  4. Bring in like-minded business people and thinkers
  5. Go Concierge or similar FFS.
  6. Treat Indigent patients 10%
  7. Back to black bag, stethoscope doctoring with New Tools.
  8. Build a base that can rise up against the CMS empire when NPI numbers control prescriptions.
  9. Provide Care for 5%-7% of the population in each state (might mean 200-2000 like minded docs in each state) – start proselytizing.
  10. Forget the loonies in DC – they are lobbyist controlled embedded clowns – both sides
  11. Join forces with AAPS, D4PC & all other entities instead of fragmenting – power in numbers
  12. Real care with limited monetary gain in the short term will lead to long term loyalty – passion brings monetary rewards if passion is the driving force.
  13. As Judith says let’s formalize the process.

These Barons are not sitting idle but they are happy in their stupor for now. Use it to our advantage. Time for checking the peeling paint is over. Substance over form. New forces will gather to self-enrich from MACRA.. & time is short!

Revolutions are never easy. Get ready to take the hits!

Not everyone in the Osteopathic community is happy about H.R. 2


Not everyone in the Osteopathic community is happy about this bill.
Your rah rah support without any mention of the potential negative consequences to independent private practice physicians is very disheartening.

What I have seen over the past 6 years is AOA acceptance of just about whatever govt takeover of healthcare that has come out of Washington. Instead of truly having an open debate on the merits and risks of bills, laws and regulations, is just the AOA following like a lapdog? Continue reading