Centers for Medicare and Medicaid Services
PO Box 8016
Baltimore, MD 21244
November 16, 2015
To whom it may concern,
The undersigned physician organizations write to comment on the Request for Information regarding implementation of the Merit-Based Incentive Payment System, Promotion of Alternative Payment Models, and Incentive Payments for Participation in Eligible Alternative Payment Models (CNS-3221-NC).
We have reviewed MACRA, the law authorizing the programs in question and the questions in the RFI. The RFI requests assistance in establishing a massive command and control structure over the practice of medicine in the United States. It assumes that codifying, tracking, reporting and imposing compliance with so called “quality” and “efficiency” measures and practices will help patients and the practice of medicine. It proposes to create a penalty system to coerce doctors to comply with cookbook medicine and rationing protocols. Experience and valid research to date have shown that such systems are harming patients, physicians and the practice of medicine.
CMS should avoid creating this system and should instead inform the President, Congress and the American people that doing so would be dangerous to patients. CMS should recognize that when functionaries create protocols and cost-control strategies that are centrally planned and removed from the patient-physician relationship, many doctors will abandon their professional obligation to patients and instead serve the centrally planned system at the expense of the well-being of their patients. CMS should recognize that so-called practice guidelines, quality measures and the like are based on political goals of the government, insurance companies, and those medical organizations seeking to game the system for their own benefit. CMS should recognize that politicization of our medical system benefits only the elites in charge and is detrimental to patients, doctors and freedom in America.
In addition, the implementation of the programs envisioned by MACRA raises many constitutional concerns and is likely unlawful under the US Constitution. The US Constitution states that our government must protect the Natural Rights inherent to its citizens. The rights to free speech, exercise of religion, and assembly are violated by the imposed command and control structure of the MACRA programs. Medicare has created a monopoly in Medical care for everyone over 65 and many disabled; Congress has forced Americans to participate involuntarily in the system through taxation. This government-created monopoly is leaving no breathing room for a true free market in which the natural rights of American citizens can be exercised. Further, constitutionally protected due process rights of patients and physicians are specifically violated by denying access to the courts under the programs created by MACRA
We call for CMS to advise the President, Congress and the American people that implementing MACRA programs described in CMS-3221-NC would be unconstitutional, unlawful and cause far more harm to patients than any intended good. CMS should request review by the courts on these matters and refuse to implement these programs until they are determined to be constitutional. CMS should stop the implementation until these programs are shown to be beneficial to patients through privately organized and funded pilot projects.
Association of American Physicians and Surgeons
Arizona Chapter, Association of American Physicians and Surgeons
Florida Chapter, Association of American Physicians and Surgeons
Missouri Chapter, Association of American Physicians and Surgeons
Texas Chapter, Association of American Physicians and Surgeons