~ Richard A. Armstrong MD FACS
Last month was a significant “milestone” for physicians in America. The periodic legislative and medical angst over the Sustainable Growth Rate was finally put to rest by the passage of MACRA (The Medicare Access and CHIP Reauthorization Act). The SGR formula, passed in 1997, was intended to limit the growth of Medicare spending on physician services by tying the rate of growth to the GDP in a complex formula. This seemed to be a reasonable idea at first but in times of economic downturn would have cut Medicare payments to physicians significantly. This has resulted in Congress overriding the SGR cuts 17 times. Each time doctors and patients were left wondering if Congress would act and Congress has been pushed to the edge too often. While this was slated to be remedied as part of the ACA in 2010, the “fix” was then estimated to add about $300 billion over a decade to the ACA budget estimate. Since the President had promised to not sign any bill that would cost one dime over $900 billion in the first decade the “Doc Fix” had to go….and it went away until last month.
Last month the MACRA bill was introduced in the House as HR-2. Most physicians received a flurry of e-mails from their specialty societies or the AMA encouraging them to call their members of Congress to urge the passage of this “Doc Fix”….finally! Just before Easter the House passed HR-2 with an overwhelming bipartisan majority. Following the Easter recess the Senate returned and quickly took up the bill as MACRA and passed it, once again with an overwhelming bipartisan majority. Excellent, you may think, wonderful news that the dreaded “Doc Fix” has finally been put to rest…right? Well, not so fast.
You see, MACRA is 263 pages long and written in typical difficult to understand legislative language. The first 11 pages deal with the repeal of the SGR. The remaining pages contain the outline of the most significant changes in the structure of Medicare payments to physicians since the original law passed in 1965. These changes are accompanied by the new buzz phrase making the rounds of medical payment systems…”value based purchasing”. What in the world is that?
Well, it has become quite the popular thing these days to blame cost overruns in federal programs on fee-for-service or paying physicians for the “volume” of what they do for Medicare patients. The Secretary of Health and Human Services has vowed to move most of the payments to a “value based system” where doctors would be paid for performance based upon “quality metrics” developed by specialty organizations. One SERMO gastroenterologist framed the situation this way:
“Perhaps this is stating the obvious, but on one hand it would seem very reasonable for the government to look to “relevant eligible professional organizations” to provide guidance in selecting everything from measures of quality to “performance improvement activities”. On the other hand, there are few (if any) such organizations that many of us feel are representative of our wishes.”
SERMO asked their physician community:
Do you believe that your specialty society fully communicated the content of HR-2 to you prior to asking you to call your members of Congress to support this bill?
81% of physicians polled indicated no
19% said yes
It seems to confirm something that many have been saying for quite some time which is a growing concern among practicing physicians. That would be that a small group of medical insiders and politicians are driving an agenda for American health care without the input or approval of the majority of American doctors.
Could that be why they urged everyone to call their members of Congress to vote in favor of MACRA at the last minute, prior to educating their members about the content of the remaining 252 pages of the bill?
What do you think?
Richard A. Armstrong MD FACS is a general surgeon currently practicing at Helen Newberry Joy Hospital in the upper peninsula of Michigan. Dr. Armstrong graduated from the Ohio State University School of Medicine in 1976 and completed postgraduate training in general surgery in 1981 at the Naval Regional Medical Center in Portsmouth, Virginia. After finishing Naval Service, Dr. Armstrong entered private practice in upper Michigan for 18 years. He has been in his current position for 10 years. Dr. Armstrong serves as the Chief Operating Officer of Docs4PatientCare.