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.

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We Must be the Paradigm Shift and Mount an Innovative Goliath Offense

Guest Post from Kris Held, MD

After spending the last 7 years treading water naively and optimistically waiting for things to be repealed and fixed and after countless trips to DC and across the country trying to cry from the wilderness of the practice of medicine from the trenches with many of you and our organizations, I am convinced this is beyond repair and will never be repealed by those in power.

The Philosophy of the architects of the current system we are floundering in is the antithesis of Hippocratic medicine and in fact works to undermine and dismantle it. Just take innovation- look at Ezekiel Emanuel’s own words on this- he believes innovation is too expensive and the taxes in Obamacare reflect this opinion. He also is an ethicist whose roots stem from his area of expertise which is dying with dignity and systems of rationing like the complete lives system. Continue reading

MOC: This Abuse Has to End NOW

Dr. Ken Lee weighs in on KevinMD blog post “The Real Cost of MOC is Stunning” :

This profession is too used to abuse . It begins in pre-med, medical school and our training as “students” where our US labor rights are violated. Even college athletes have won a Federal case to get classified as employees of the colleges that were using them as “students”.

We have to influence our colleagues to stop swallowing each cup of poison they want us to drink. The costs of MOC for Int Med exceeds what I get paid from any contract I have with United, Aetna or Cigna, making the MOC a huge loss anyway you look at it. The summer months are supposed to be slow for medical care but I was seeing 23 patients a day with another 90 minutes of computer work at night to just do the documentation, MU, PQRS etc.

The only way I could do MOC is to not sleep or sacrifice my family time which my wife says will never happen again as she has seen hundreds of hours lost in the past due to the re-certification exams. I have lost entire weeks of my life for this certification scam.

The human cost of MOC is not fully exposed and must be. The hundreds of hours of our scarce free time is lost for trivial pursuit that we all know does NOT improve patient care ( 2 JAMA studies 2014 prove this ) . The psychological toll of fear , potential loss of income and actual loss of money on this coercion is glossed over, as if we were all CEOs making $4million a year at a non-profit hospital.

I never see written interviews of the families who suffer the absence of a parent who is hostage to recertification /MOC; what does it do to them? This abuse has to end now . People call us doctor which seems to elevate us but in reality we have become almost slaves. One of my long times friends finally got his BA degree and he runs a hospital physician system that employs 22 MD/DOs ; they have to answer to him . So much for the doctor title.

Ken Lee , Internal Medicine, private practice.