In repealing the automatic Medicare physician fee cuts called the SGR (Sustained Growth Rate), Congress replaced it with something worse, in the opinion of ophthalmologist Kristin Held. M.D., in the summer issue of the Journal of American Physicians and Surgeons.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) set up the Merit-based Incentive Payment System (MIPS). MIPS grades individual physicians with a composite performance score between 0 and 100, and posts it on the Physician Compare public website, Dr. Held explains. The score is determined by the doctor’s weighted grade in four performance categories as set forth in a federal government rulebook. The doctor is rewarded or penalized by an increase or decrease in pay, she states.
MACRA vastly expanded the federal government’s control over patient care and the patient-physician relationship, Dr. Held writes. “The stated goal is to drive physician behavior…. Government seeks to move physicians away from a fee-for-service payment model and into alternative payment models that are claimed to reward what government perceives as value-based care and that require ‘providers’ to assume significant financial risk.”
But who determines value, Dr. Held asks. And “we [physicians] must ask ourselves again: Whom do we serve, the patient or the state?”
“One of the four MIPS performance categories, Advancing Care Information (ACI)…is especially disconcerting,” in her view, “as it requires physicians to fully disclose all of our patients’ medical information to government data auditing agencies…, including…all demographics, all medical history, all medications ever taken, and even genetic information. The physician who does not comply will receive a score of zero (0) in the ACI performance category.”
All patients, not just Medicare patients, are affected, Dr. Held warns. “The federal government wants to collect, audit, assess, and sell the patient data and wants to be able to input government treatment guidelines, templates, restrictions, and controls. In effect, the federal government wants to dictate the medical care of the American people.”
Dr. Held cites abuses of data collection and surveillance of American citizens by many federal agencies, such as the Federal Bureau of Investigation and Internal Revenue Service, and cautions against expecting better behavior by agencies within the Department of Health and Human Services. Compromise of medical data might be even more damaging than exposure of phone conversations, e-mails, texts, and finances, she suggests.
MACRA needs to be repealed, she writes. “The MACRA rule-making process revealed how this law could be too easily and too vastly contorted beyond the sponsors’ intent.”
Dr. Held’s article is available at: http://www.jpands.org/vol23no2/held.pdf
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.