Medical Tuesday Blog

CMS Paying Doctors Based on Quality is counter-productive

May 30

Written by: Del Meyer
05/30/2017 6:48 AM 

U.S. Officials Finalize Rule for Medicare Payments to Doctors

By Melanie Evans | WSJ | Oct. 14, 2016

Federal health officials on Friday finalized a new rule for how Medicare pays U.S. doctors, part of a broader push by the White House to overhaul federal health spending.

The Centers for Medicare and Medicaid Services released the highly anticipated rule, which introduces new bonuses and penalties tied to performance for 712,000 doctors and other clinicians starting in 2019.

The new bonuses and penalties would be paid or imposed depending on how well doctors do on measures of quality, electronic health records and managing costs. 

Doctors can also enter Medicare contracts that include quality and cost-control incentives and earn bonuses. . .

Doctors must begin reporting data on performance next year, but under a recently announced change, doctors can avoid penalties as long as they report some quality data. . .

Physicians groups had mixed reactions to the new rule. The American Medical Association praised the CMS for its flexibility in a statement and said the association was reviewing the rule’s details.

The Medical Group Management Association said in a statement. . . “The sheer magnitude of a 2,400-page regulation and its impact on physician practices can’t be ignored.”

Anne Phelps, U.S. health-care regulatory leader for consultant Deloitte, said the new rule would be as significant for clinicians as the Affordable Care Act is to insurers as it pushes doctors into a new model for payment. “It’s a disruptive law,” she said.

Read the entire article . . .

Editor’s Comment:
Doctors spend eight to twelve years after college to learn their profession. Quality is drilled into them daily. In fact, the professors strive to make quality our middle name. They succeed in 99 percent of us. Then who betrayed us?

It was initially primarily our own trade organizations: the medical associations. In the above comments, you will note that the American Medical Association praised the CMS for its flexibility. The Executive Director of California Medical Association has frequently highlighted the need to improve that Quality of Care of their doctors. The Executive Director of our local Medical Society has praise the increasing acceptance of our doctors to see Single Payer and other names that Government Medicine goes by. This has over the 45 years that I’ve observed these administrative comments made me wonder why our trade organizations hire administrators who seek to destroy private personalize medical care. Why is it that the destructive elements in almost any organizations seem to come from within? Why aren’t our trade organizations, who seek to be our Union, just as the British Medical Association is a Union to support doctors in the National Health Service, supporting us? Can you even fathom a Carpenter’s Union not going to bat for the Carpenters instead of hounding them on how to improve the quality of driving nails in construction? Can you imagine the Carpenter’s spending time to go to Union demanded workshops to improve their carpentering skill? I bet the Union leaders would start wearing helmets—not to protect themselves from falling boards, but from the carpenter’s Hammers.

This has now metastasized into some of our professional organizations. There are notable exceptions however. The Neurosurgeons, Orthopedic Surgeons, Ophthalmologists and perhaps others that understand the change and the associated destruction as well as corruptions that comes with government intrusion into our profession.

You will note that our pay will be determined by how well doctors do on measures of quality, electronic health records and managing costs. The first determination of pay is irrelevant since “quality” is our middle name and all the practice restrictions impose on us actually reduce quality. They are actually trying to teach us “not to think.” This will be explored further in our companion quarterly newsletter, HealthPlanUSA, in detailing how the government has destroyed health care quality and why doctors have not rebelled.

Our use of electronic health records should not determine our pay or quality. There are increasingly papers written where EHRs have nearly destroyed the personal doctor patient relationships. I’ve had patients who changed doctors stating that their prior physician in their HMOs never looked at them while they recited their medical problems. Some even said they didn’t feel that they were treated as a human being. This will also be detailed further in HealthPlanUSA newsletter.

The third criterion for our pay was the managing of costs. The government expects us to be the cops when they pay full price for their care and still expect us to reduce our tests while our patients demand more, and more, and more tests and x-rays and costly procedures. This could all have been solved by keeping the original Medicare method of the patient paying 20 percent of their outpatient costs. That simple maneuver would have cut the tests that were done in half. The attitude of patients would have been reverse from “more and more” to do I really need those extra tests?

It is indeed unfortunate that doctor’s pay is dependent on these MYTHS. That will more likely not change in the present government controlled environment. Perhaps the government control will relax under the new leadership that was voted in.  –Editor

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