By an overwhelming bipartisan vote, Congress recently enacted a bill that will drastically change how physicians are paid. According to Richard Amerling, M.D., president of the Association of American Physicians and Surgeons (AAPS), the Medicare Access and CHIP Reauthorization Act (MACRA) brings into clear focus the destructive effect of Medicare.
The draconian pay cuts called for by the maligned “sustainable growth rate” (SGR) formula that MACRA “fixed” were a recent continuation of efforts, beginning immediately after Medicare passed, to contain costs by putting price controls on physicians. Amerling summarizes these in the summer issue of the Journal of American Physicians and Surgeons.
“Pay cuts to doctors predictably cause total spending to increase,” he writes, and they can’t help much because doctors’ pay only represents 10 to 12 percent of total spending.
MACRA is the same old price controls, with more bureaucratic hoops, he states. And “it furthers the destruction of private medical practice through a frontal assault on fee-for-service payment.”
It claims it will pay for “quality,” but Amerling explains the impossibility of defining quality—referring to the book Zen and the Art of Motorcycle Maintenance by Robert Pirsig.
Adapting Pirsig’s analysis to medicine, Amerling writes that Quality “occurs at the cutting edge between subject and object, the patient-doctor interaction. Anything that enhances this relationship improves Quality; anything that interferes with it destroys Quality.”
The new payment mechanism replaces the patient-physician relationship with “practice guidelines” and “evidence-based medicine.” Amerling presents guidelines for treating anemia in chronic kidney failure as an example of disastrous failure.
“We are at a critical juncture,” he concludes. “We can continue to allow Medicare and the corporate payers to control our lives, limit our fees, force us to disclose confidential information, [and] prescribe based on pseudo-scientific constructs…. Or we can break free. We can declare independence. We can opt out of Medicare. We can cancel our abusive insurance contracts…. We can become healers once again.”
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
Download Article: http://www.jpands.org/vol20no2/amerling.pdf