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

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Physicians must take back control over definition of quality in medicine

Guest Post by Cynthia Marcotte Stamer, Esq.

Balanced billing is an important element, but only works if physicians recapture control over the quality question.   That’s why in addition to anything else physicians do, physicians must work to take back control over the right to define quality in medicine by controlling or beating back payer driven, cost motivated PQRS and other quality rankings that demonize physicians for practicing better medicine than what payers want to pay for both by demanding meaningful input to the design and quality standards and processes, pushing for reform that prevents payers and the government from misaligning and punishing physicians that put patients first, and other actions that ensure that patients put their confidence and control of care in the hands of physicians not payers or the government.   CMS recently extended the comment deadline on the 2016 PRQS Quality Measure Plan to March 1.  See CMS Seeks Public Comments on Draft Quality Measure Development Plan (MDP) by March 1, 2016 (1-29-2016). See here.  I urge everyone to review and submit meaningful comments on these proposed quality measures as whether or not you use to participate, they will be used to rate you. 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.

PQRS MOC Incentive Program Eliminated

Via Dr. Paul Kempen:

Good news! Even the ACA and the congressmen have listened and destroyed the PQRS-MOC incentive-if we can only believe the ABIM and they probably are telling the truth on this one. The continued decline of ABMS and ABIM power base is evident!

“As of January 1, 2015, the PQRS MOC Incentive Program will no longer exist. The Affordable Care Act (ACA) enacted the program as a way to encourage physicians’ participation in the Physician Quality Reporting System (PQRS), while also recognizing the value and importance of American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) programs. ABIM participated as a member board from 2012 through 2014. The ACA ended the PQRS MOC Incentive Program after 2014 (though the underlying PQRS program continues).”

https://www.abim.org/maintenance-of-certification/additional-credit-for-earning-points/physician-quality-reporting-system.aspx

AOA should represent the private practicing osteopathic physician

Bob Maurer, DO writes the AOA President and President-Elect

Bob and John:

One year ago, at the AOA convention, I asked to meet with Dr. Vinn to give him my perspective on the concerns of the general AOA membership. I came to him as a long time AOA member and NJAOPS leader.

He started off the conversation by calling me a bully and telling me that I do NOT
represent any AOA members. He refused to listen to any of my suggestions.

Continue reading

Death By a Thousand Cuts

The Robin Hood analogy of “taking from the rich and giving to the poor,” is completely the opposite for those who are struggling to get by on what they make.

The minimum wage earner flipping burgers has money taken from his meager paycheck to pay for Medicare. Those who are on Medicare have assets (own their own home, savings, pensions etc.), and are relatively “rich” compared to the minimum wage worker.

Thus, in many instances, the government takes from the poor and gives it to the rich. Continue reading

Open Letter to All Physicians

D.O.’s and M.D.’s are up in arms about all of the mandates coming down from the federal government, state governments, insurance companies, HMO’s, malpractice carriers, and hospitals.

U.S. physicians are the most over-regulated profession in history.

Doctors, both D.O.’s and MD’s, are particularly disturbed when many of the onerous mandates are instituted by their own parent organizations that were supposed to be representing them.

Let’s work together to turn it around.  AOA and AMA should send a message to all of their members that these membership organizations now actively oppose Maintenance of Licensure procedures that are being promoted by the FSMB.

After that, we can start working on the restrictions created by OCC, MOC, ACGME, ICD-10, CAP, PQRS, Needs Assessment, COMLEX, and all the other burdensome acronyms.

Respectfully submitted,
Robert S. Maurer, D.O, a concerned physician