Keep the pressure on your Senators. Call them TODAY and tell them to vote NO on H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA). Click here for contact information for your Senators.
Your efforts are making a difference. Because you are speaking out, the establishment’s spin machine is running in overdrive to cover up the problems with this bill.
The Texas Medical Association has even resorted to name-calling to silence critics of this bad bill, shaming “internet trolls” who are “spreading lies” about H.R. 2.
Here is a guide that breaks through the propaganda to aid in discussing H.R. 2 with your colleagues, patients, and elected officials:
H.R. 2 Unspun
SPIN: H.R. 2 was developed by Republicans, not in a secret deal between Boehner and Pelosi, thus it is good and should be passed.
REALITY: Whoever developed the bill, it is bad, and Pelosi and Obama like it. All kinds of unrelated things are buried in its 262 pages. It’s another Pelosi Special “we have to pass it to find out what’s in it.”
SPIN: This bill preserves the right to “private practice” and “fee-for-service.”
While fee-for-service is not outlawed by H.R. 2, the additional red tape imposed by the bill will increasingly drive independent physicians out of the profession entirely or into the employ of hospitals and insurers. It “furthers the push away from fee-for-service payment in favor of newer forms of managed care, such as the Accountable Care Organization. These, despite the bells and whistles, are doomed to fail,” writes AAPS President Richard Amerling.
Texas physician Patrick Roughneen notes, “We will now be asking doctors in this country who provide Medicare services to undergo expensive and unrealistic documentation requirements in order to be paid. The only result will be a departure by physicians providing services to these needy patients.” Not to mention the bill preserves Medicare’s price controls which exacerbate shortages.
SPIN: “This bill has nothing to do with MOC (maintenance of certification) or MOL (maintenance of licensure) requirements.”
REALITY: The bill gives CMS the authority to “contract with entities” like ABMS and ABIM to “specify criteria” for “clinical practice improvement activities” and determine whether “professionals meet such criteria.”
“Portions of this program [MOC] will be used as a physician reporting measure,” notes Dr. Wes Fisher.
Earlier this week, noted investigative reporter Kurt Eichenwald (he helped uncover the Enron scandal) reported in Newsweek: “And now it looks like the government may have been lobbied to create more pressure on physicians to shell out cash to ABIM and its brethren. This time, it’s through [HR 2]. Among its provisions is one where doctors would qualify for a new incentive pay system in Medicare by meeting quality standards established by the government in consultation with certification boards like ABIM.”
In fact, in 2013 ABMS explicitly lobbied Congress asking for MOC mandates to be included in SGR replacement legislation. “ABMS MOC® … should be foundational to any future system,” states an ABMS Senior Vice-President in a letter to the U.S. House Energy and Commerce Committee.
SPIN: H.R. 2 is a fiscally responsible bill.
AAPS Executive Director Jane Orient, MD further explains: “Assuming that SGR would take effect is indeed a budgeting gimmick, but HR2 contains plenty of budgeting gimmicks. The only likely ‘savings’ will come from increasing premiums to the ‘rich’ and limiting first-dollar coverage through Medigap. ‘Alternate’ [non]payment methods add overhead but decreased spending is purely hypothetical and relies on giving less care.”
SPIN: H.R. 2 reduces bureaucratic red tape for physicians.
REALITY: Rolling several regulations into one and changing the name hardly decreases regulation. According to former Bush Administration adviser Yuval Levin, “This is basically a replacement of a blunt technocratic instrument with a fine technocratic instrument—and fine technocratic instruments are very often even worse, indeed much worse, than blunt ones. The portion of the bill laying out how this is supposed to work adds up to a 120-page demonstration of why the government should not be acting as a health insurer. “
SPIN: The bill doesn’t require Medicare participation by physicians and removes the requirement that opted-out physicians renew their opt-out every 2 years.
REALITY: We are not aware that anyone said H.R. 2 requires participation in Medicare. It just imperils the ability of beneficiaries to get coverage of services ordered by opted-out physicians. We’re all for ending the ridiculous re-opt out requirement. This can be done without H.R. 2. In addition, physicians and seniors must be allowed true freedom to escape the financially insolvent program.
SPIN: H.R. 2 “guarantees small, but real, increases in physician payment rates for the next five years.”
REALITY: The bill continues the freeze on physicians’ rates that began in the 1980s. It just adds a tiny amount to the frozen price. H.R. 2 “does away with the SGR, but enshrines Medicare price controls and an arbitrary update formula guaranteed to be substandard,” writes Dr. Richard Amerling.
SPIN: H.R. 2 does not harm a patient’s right to medical privacy, nor does it require a physician to turn a patient’s medical record over to Medicare.
REALITY: If patients’ records are entered into an interoperable data registry, without consent or ability to opt out, with access to any government-authorized entity, this is no different from turning records over to the government.
The Citizen’s Council for Health Freedom reports on the mandatory data sharing aspects of H.R. 2: “To access patient data used to impose controls on doctors, the bill states: ‘Congress declares it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018.’ (Section 106 (b)) The bill also prohibits blocking of access to patient data, essentially forcing every electronic health record company to become a public utility for nationwide data-sharing.”
SPIN: Don’t worry about requirement in H.R. 2 mandating an NPI for prescriptions to be paid for by Part D.
REALITY: The bill may give HHS the power to invalidate a physicians’ NPI, and some pharmacies are already refusing to fill prescriptions without an NPI even if the patient self pays. In addition, H.R. 2 strengthens CMS’ policy of demanding an NPI for all services ordered by physicians even if they are not the party receiving payment for the service. This puts in jeopardy the ability of beneficiaries to get coverage of services ordered by opted-out physicians.
SPIN: “No piece of legislation is perfect, but HR 2 is a far cry better than the status quo.”
REALITY: For the reasons outlined above (and numerous reasons unstated) the bill is not only imperfect, but unacceptable.