Death by Regulation


This week’s health policy news roundup curated by Jane M. Orient, M.D.

Farzad Mostashari, who spent two years leading the White House effort to implement electronic health records, has argued that Medicare’s new physician payment rule would be “financial suicide for small practices.”

Later he said “I regret [saying that], a little bit. I don’t believe that there is a campaign out there to kill the small practice of medicine.”

He has also said, “I don’t think regulators want to be blood-letters,… [but] “maybe some people should go out of business … if you can’t keep up.”

He imagines physicians saying “I need to check the stupid box, to get a stupid check,” and acknowledges that that “kills the spirit.”

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) piles still more on top of Affordable Care Act (ACA or “ObamaCare”) regulations. By 2016, with the help of hundreds of new ACA regulations, HHS’s paperwork burden has increased to roughly 700 million hours, an increase of more than 300 million hours since President Obama took office, writes Sam Atkins of the American Action Forum. The ACA’s regulatory burden has already topped $45.5 billion, and much worse is on the way before the end of Obama’s term.

Organized medicine, having fought for the “reform” that resulted in MACRA and its 962 pages of regulations, is applauding the rule’s likely positive impact on quality of care, outcomes, and efficiency, while acknowledging that small practices are likely “losers.”

The American College of Physicians (ACP) is urging internists to “be prepared” and learn about the overwhelmingly complex rule in “bite-size pieces.” Small practices are “not always set up to do the necessary large data analyses,” said ACP vice president Shari Erickson. “One of the key things is to start to understand it. It is complex and will become more complex as we move toward implementation, but if you can start to do the items on the top 10 list that we’ve come up with—maybe not all at once, just identify a couple to start now—you can make progress.”

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