Before leaving for recess, the House of Representatives passed a bipartisan bill that repeals the 21 percent Medicare fee cut dictated by the Clinton-Gingrich “sustainable growth rate” (SGR), and replaces it with something far worse for doctors and patients.
The Association of American Physicians and Surgeons (AAPS) urges the Senate to vote the bill (HR 2) down.
HR 2 does not repeal the Medicare price controls that began in the 1980s, which are the cause of limited access to care and misallocation of resources, notes AAPS president Richard Amerling, M.D. It gives a tiny “update” in allowed fees, which does not begin to cover the increase in practice costs.
Worse, it adds oppressive bureaucratic practice controls. It demands that doctors use an “alternative payment methodology,” which means payment for something other than doing work. This includes compliance with government directives, patient outcomes that are largely outside a doctor’s control, and “saving” money by not providing services.
After reading the 263-page bill, Kris Held, M.D., an ophthalmologist, notes the following features:
- The MIPS (Merit-Based Incentive Plan System) with Composite Performance Scoring of physicians (a report card), which could be used to cut a physician’s pay by as much as 9 percent;
- Interoperable electronic health records, with complete access to no-longer-confidential patient medical records by clinical data registries chosen by the Secretary of HHS;
- A requirement, §507(4), that pharmacy claims have a valid physician National Provider Identifier (NPI) and gives the Secretary power to require an NPI for all claims submitted for items and services;
- Authority for the HHS Secretary, §507 (4)(B)(i), to establish procedures for determining validity of a physician’s NPI and thus allowing or disallowing patient access to drugs or tests ordered by that physician.
In addition, HR 2 grants CMS the authority to “contract with entities” like the American Board of Medical Specialties (ABMS) to “specify criteria” for “clinical practice improvement activities” and determine whether “professionals meet such criteria.” This opens the door to increased federal coercion for participation in ABMS “Maintenance of Certification” (MOC) or related schemes which are harmful to the timely delivery of medical care.
“You won’t miss SGR until it’s replaced,” writes Jane Lindell Hughes, M.D., an ophthalmologist. “The system will codify ‘population based care,’ which is the purpose behind the World Health Organization’s ICD10 codes, which are mandatory by Oct 1, 2015.”
The crisis of impending severe doctors’ pay cuts provided the vehicle for tacking on provisions that, according to Dr. Held, threaten “to destroy the patient-physician relationship, the Oath of Hippocrates, and the practice of private medicine in the U.S.” Physicians cannot ethically practice under such a system.
The 21 percent cut may be what is needed for doctors to realize that “we have sold the soul of our profession to the government and third party payers,” suggested Dr. Hughes.
AAPS provides detailed information on opting out of Medicare.
The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943 to preserve private medicine and the patient-physician relationship.
