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

Patients can recognize quality. That’s what really counts.

Dr. Alieta Eck writes in:

Why do we need a big study on what makes a good physician? The answer is clear to most of us out in the day to day physician world.

A good physician is one who connects with his patients and really cares about them. He makes the patients feel at ease and willing to divulge their most intimate details, since they realize that any detail might be relevant.

A good primary care physician has taken the time to learn the family dynamics that impact the psychological make-up of the patient. He attends the funerals of select patients as he knows this will help the grieving process of the family, and they are also his patients.

A good physician has had good training and keeps up with the latest diagnostic and therapeutic regimens. He has developed a good referral network, so he knows his patients will get the same concentrated attention that he gives. He would never refer to someone he would not entrust with his own family member. A good physician can recognize the qualities in other good physicians.

We do not need tests to measure good physicians. We need continuing education so physicians and keep up and learn what to measure in our patients to detect and monitor illnesses.

If anything has decreased the quality of our care, it has been the theft of our time by government and hospital corporations like the Joint Commission that has added the extra burdens of paperwork and form-filling to our duties as physicians. Or the participation in HMOs that so underpay, we need to have 5 instead of 30 minute visits.

Patients know who the good physicians are and need to be free to choose them. Insurance companies herd patients into provider networks, but many patients see the difference. Recently we have had patients return to us after 10 years, lamenting their experiences with doctors they did not feel we’re paying attention. They are willing to pay cash to see us as they understand value.

I guess that might indicate that my practice has good physicians in it. I am a grandfathered internist, so I have never re-certified and do not intend to participate in MOC. My husband did 3 years of general surgery and 3 years of family medicine residency. He is an excellent physician with a wealth of experience. He refused to participate in the re-certification testing scheme, as it never made sense to him, especially since I was exempt. But after 25 years the credentialing secretary caught up with him and he was dismissed from the hospital staff.

This broke the hearts of many of his long-term patients, but the bureaucrats didn’t care about how his patients felt. Their goal was to proudly state that all their physicians are “board certified,” as if the public really cared.

The “public” simply wants to know that their physician knows how to fix what ails them and will be by their side when they need him. Studies have shown that patients never ask if their doctor participates in MOC. They really do not care one iota.

Patients can recognize quality. That’s what really counts.

Alieta Eck, MD