- - Wednesday, April 15, 2015

Last month, the House of Representatives passed H.R. 2 (the Medicare Access and CHIP Reauthorization Act of 2015) at the 11th hour to avert a looming 21 perent cut in physician Medicare payments mandated by the archaic Sustainable Growth Rate (SGR) system. The Senate has now followed suit, passing the measure on April 14. With much fanfare, the bill’s champions announced they were finally tackling entitlement reform with repeal of the SGR. 

But with what are they replacing it? 

A detailed look at the provisions in H.R. 2 reveals a convoluted, top-down system with much of the White House’s radical plan to change how doctors get paid woven into every page. With the change in the payment system comes major changes in the Medicare patients’ relationship to the government and the physicians’ ability to craft individualized care for each patient. Under the guise of controlling costs, H.R. 2  ultimately contributes $500 billion to the deficit, according to the Center for a Responsible Budget.

The new Health and Human Services (HHS)/ Center for Medicare and Medicaid Services (CMS) payment system is called the Merit-based Incentive Payment System, or MIPS. Rubrics requiring mandatory utilization of electronic medical records (EMR), proof of “meaningful use” of those records, outcomes-based practices (yet to be developed by HHS), and participation in alternative health delivery systems will be used by HHS/CMS to rate the “quality” of every doctor on a scale of 0 to 100. That score will be publically posted. Poor ratings can mean as much as a 9 perent decrease in payments. Contemplating the logistics of tracking every physician on each one of these strands, complying with the burdensome reporting requirements, and the actual grading of physicians by non-medical bureaucrats is mind-boggling, if not ludicrous.

As if all that weren’t enough, there’s also plenty in H.R. 2 that impacts the Medicare patient. The mandatory EMR must be “interoperable,” allowing “Qualified Data Registries” (QDR) to access an individual’s medical record. The QDR are selected by the HHS Secretary and include government agencies, insurance agencies and health organizations. These entities can mine data for use to develop treatment protocols, codify “population based care” and other uses. This places the government and other entities in the examination room using the physician to gather information on his patients for government use. This erodes the privileged and private relationship between physician and patient, which is a crucial component of appropriate medical and surgical care. Finally, H.R. 2 includes the mandatory conversion to the new World Health Organization ICD-10 diagnostic coding system, which is about finance and epidemiology, not true quality of care. Although those favoring ICD-10 anticipate large financial rewards, it is estimated that it will cost the average physician upwards of $40,000 to implement ICD-10. Furthermore, HHS is advising physicians to have 3 to 6 months of cash available to meet practice expenses because of anticipated massive disruptions in payments as the conversion is made. Never mind that the current ICD-9 works well and ICD-11 is due in 2 years. This conversion is mandatory by October 1, 2015. 

HHS/CMS says they are ready for the conversion, but then these are the same people who said they were ready with Healthcare.gov. This mandate, coupled with the EMR requirement (estimated to cost at least $40,000 per practitioner above what HHS pays for adoption) will put solo and small practices at risk for financial insolvency. Many physicians will leave practice or opt out of Medicare, making access for Medicare patients difficult and 2-tiered.

This bill shifts the expense of medical care to the expense of bureaucratic compliance and control. It also shifts the attention of participating physicians from concern for their patients’ care to concerns about checking the correct boxes and risk-avoidance. 

Much of H.R. 2 bears a striking resemblance to the central planners’ vision of full implementation of Obamacare. We’ve already witnessed the 34th version of Obamacare and over a billion dollars wasted on 7 exchanges that have collapsed. HHS Secretary Sylvia Burwell recently halted a safety program designed to track individually labeled medical and surgical implantable devices stating HHS/CMS did not have the technology or the resources for implementation. Taking her at her word, how then can they possibly implement H.R. 2?

To get back on a fiscally sound path in Medicare that also supports human dignity and the sanctity of the doctor/patient relationship, we need less government distortion, not more. Replacing one bad system with something worse is not a solution. 

Section 1801 of the 1965 legislation creating Medicare reads, “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided…” H.R. 2 is the antithesis of the spirit of the original law.

With the 2014 election and changes in the House and Senate, one might have hoped for more patient-centered, physician-guided, market-driven solutions for Medicare. H.R. 2 is Obamacare dressed in Medicare clothing. Sadly, the Senate doesn’t allow the same mistake twice.

Jane Lindell Hughes, M.D., is an ophthalmologist/ophthalmic surgeon in San Antonio, Texas and a co-founder of AmericanDoctors4Truth.

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