Blood, Guts, and MACRA

DR-Exit: Sean MacStiofain said “most revolutions are caused… by the stupidity and brutality of governments.” Regulation without legitimacy, predictability and fairness always leads to backlash instead of compliance. If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable. Once DRexit begins, there will be no turning back.

2020-05-14T03:29:09+00:00February 28, 2017|Categories: Policy|Tags: , , , , , , , |

Gaming the System: Pediatrics, Mammograms, and MACRA

Imagine what quality metrics the pediatric cardiac surgeon is going to track. He would do well to collect statistics on how often he images patients for appendicitis because it is likely a rare occurrence. Things are really looking up for the use of data and technology in healthcare. Costs are likely to keep rising with everyone scoring in the 99th% percentile once they figure out how to game the system. But we certainly cannot stand in the way of science or progress now can we?

2020-05-14T03:27:54+00:00February 21, 2017|Categories: Policy, Practice|Tags: , , , , , , |

Meaningful Use: A Bird’s Eye View from the Penalty Box

Welcome to the penalty box, with no term limit. Every single visit, procedure, counseling session, or medical intervention will have 2% shaved off the top. The average family physician receives about $100,000 a year in Medicare reimbursements, so a 2% penalty for 2017 will become 3% in 2018, and increase to 4% in 2019—a combined three-year total of $9,000.

2020-05-04T01:54:53+00:00January 24, 2017|Categories: Policy, Practice|Tags: , , , , , , |

Going Rogue

As the reality of MACRA (Medicare Access and CHIP Reauthorization Act of 2015) looms, the pressure is on small practices to survive. CMS plans to penalize 87% of solo physicians and reward bonuses to 81% of practices with more than 100 physicians. It is time for passive resistance, defined as protesting against a law using peaceful methods such as refusing to obey or refusing to leave a building. I vehemently refuse to leave the building.

2020-05-03T23:02:44+00:00July 20, 2016|Categories: Practice|Tags: , , , , |

Dear Mr. Slavitt, Please Come Visit My Office.

My county with a population of 260,000 has NO psychiatrist. Not one. Many states all over are experiencing the same provider shortages. Can you grow psychiatrists somewhere at an accelerated rate, like that clone army in Star Wars, and drop them randomly by plane throughout the United States? That would be a good start. They could be raised to believe indentured servitude is their destiny.

2020-05-03T23:08:20+00:00July 12, 2016|Categories: Policy, Practice|Tags: , , , , |

CMS + MIPS/APM = Death of the Private Practice Physician.

We should pay physicians for time spent engaging patients in conversation, instead of rewarding them for checking boxes on a computer screen. Physicians were trained to care and comfort people, not chase blood pressure numbers and pain scale scores. Changes masquerading as meaningful have only increased physician workload. We are widgets in the ever expanding assembly line. Do you think the MIPS will give us more time to practice medicine? If you believe it will, then I have a bridge to sell you.

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