Last year, Congress passed the MACRA bill into law ending their ill-devised SGR (Sustainable Growth Rate) formula. Basically, this was a formula to decide how to reimburse health care providers but they miscalculated. It never worked from the onset and after a decade, MACRA was devised to “fix” it. When MACRA was rolled out, the requirements were not, thereby putting into law a bill that its components were yet unknown.
On April 27, 2016, CMS released the components of this new bill. While it does set out to balance the budget, it does so at the expense of physician reimbursements. There are bonuses for some and negative adjustments for others. But, those hit hardest will be solo doctors and those in small practices.
Over the past decade or so, our reimbursements did not increase despite soaring overhead costs. Yet, data released by CMS suggests that solo doctors will face negative adjustments to the tune of $300 million. We simply cannot afford that. Additionally, of solo practices, 87% will suffer negative adjustments, as CMS refers to it.
Behavioral Health, Interoperability and eConsent: Meeting the Demands of CMS Final Rule Compliance
In a webinar on April 16 at 1pm ET, Aneesh Chopra will moderate a discussion with executives from DocuSign, Velatura, and behavioral health providers on eConsent, health information exchange and compliance with the CMS Final Rule on interoperability.
Negative adjustments may not sound that bad but let’s call it what it is: pay cuts, for the same work. In what other profession would this be acceptable? Yet, doctors are not allowed to collectively bargain or strike, we can just bear the rules shoved down our throats.
Large practices stand to gain under the new healthcare ecosystem. In fact, practices with more than 100 doctors will enjoy the largest positive adjustments. It is estimated that more than 80% of practices of this size will see pay increases.
Where is the quality incentive when reimbursements are based on practice size? Small practices just cannot compete on the same level nor should we be expected to. I see my patients and try to give them the best medical care. Yet, CMS apparently is extolling assembly line medicine and patients will be the biggest losers here.
By passing these regulations, law makers effectively killed private practices and many wonder why. But, many doctors see the over-reach of the government in the exam room every day. We know this is a step in the direction of single-payer government run healthcare. The private practice doctors are no longer burdened with the weight of useless and ridiculous mandates on our shoulders. We now have the noose around our necks and Congress is pulling the knot.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The US is an economy that thrives on capitalism. Yet, in medicine, those who want to provide quality care for patients are being driven out of business. Many look to the example of Marcus Welby, MD as the kind of doctor they want. Well, he is now dead and the government has killed him.
The future of healthcare in the US has been drawn out. Americans will only be able to seek care in large practices. Don’t expect personalized care. The government doesn’t care about you. only your numbers. Do we really want those who mismanaged Medicare running our medical system?
As a doctor in the US, I cannot strike like the juniors doctors in the UK are now doing. It is illegal for doctors to do so. We cannot change the policies lawmakers issue for their own political agendas. We can opt-out and stop taking medicare and perhaps the time to talk with our feet has arrived. And the big mega-practices can pick up where we left off. The death bell of private and solo practice rang and we can only watch in despair.
