Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

If Medicare wants value, it should cancel MACRA

Matthew Hahn, MD
Policy
November 13, 2017
643 Shares
Share
Tweet
Share

From the CMS website, October 30, 2017, “Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation … We need to move from fee-for-service to a system that pays for value and quality — but how we define value and quality today is a problem. We all know it: Clinicians and hospitals have to report an array of measures to different payers. There are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient care.”

Then cancel MACRA, Ms. Verma. You’ve just admitted it’s a bad plan. Cancel it while there’s still time.

MACRA, for those who don’t know about it yet, is the next way that the federal government is going to ruin health care. It’s another layer of senseless rules, data collection, and more rules—this time based on the new fad known as “value-based payment.” This new form of government excess is an amalgam of every failed attempt to do the exact same thing in the past. It didn’t work then, and it won’t work now. Here’s why.

MACRA has four categories of value: quality measures, advancing care information, cost, and improvement activities. Data is collected for each of the categories and doctors will either be paid more, or penalized, based on the results.

Quality measures replaces the government’s PQRS program, where the government collects data that purportedly reflects the “quality” of a physician’s clinical practice, things like blood pressure control for patients with high blood pressure, and glucose control for patients with diabetes.

Let me tell you one of the reasons why there is little point to collecting this data. Here’s an actual appointment that took place last week. A patient with Medicare D prescription coverage came in for a number of problems. First, though, she showed me two letters she had received from CVS Caremark, her Medicare D prescription administrator. The first was a cancellation notice for her long-time blood pressure medication, a generic beta blocker. The second was a cancellation for her statin.

The letter asked her to have her physician call a phone number to discuss the issue. I dialed the number, and was put on hold for about five minutes. Then, Debbie picked up, and I explained the issue. She put me back on hold for a few more minutes.

I decided to use this hold time as best I could. I held the phone in the crook of my neck and began discussing the patient’s two other medical issues. After a few minutes, someone came back on the line. I explained about the letters. She said that she was not the Medicare D person, and put me back on hold. I continued to interview the patient. After a few minutes, Monique came on the phone. I again explained what was going on. Monique figured out that both letters were in error. She said she would fix the mistakes. Total time on the phone: about twenty-five minutes.

Here’s the system of value within which we practice. To bring value in this sense, which is to control patients’ blood pressures, I have two options. I can encourage the patient to eat right and to exercise, which I always do. But I have a limited ability to control that aspect of their lives. Second, I can prescribe appropriate medicines. But, as we see above, the federal government, in the form of this Medicare D prescription service, makes this quite difficult.

I am held responsible for value when I have, at best, limited control over such things, and at worst, a system that blocks genuine value at almost every step.

The second value category is advancing care information, which replaces the government’s failed EMR program, meaningful use. With this program, the government hopes to force doctors to use EMRs more “meaningfully.” What they fail to acknowledge is that for many doctors, EMRs are the worst thing that ever happened. They slow them down, distract them, force them to write inane long notes, and just don’t work in a multitude of other minor and major ways. Maybe worst of all, they disrupt the connection between doctor and patient, because many of them are just so clunky that they divert the doctor’s attention completely away from the human being (the patient) sitting in the room with them.

There is no value in using such systems, no matter how much data the federal government collects or how much they penalize doctors whose data is not up to snuff.

The third category is cost. The government is going to compare the relative cost of each doctor’s patient care. This makes no sense at all. I have no control over what tests or treatments cost, and very little control over where my patients receive their care, other than my office. Some hospitals charge a great deal more than others. Not only that, I don’t have any idea what anything costs. No one does! Hospitals make this information a state secret.

And what if I just so happen to take care of a larger number of sick patients than other doctors? The clear incentive is to withhold care —
no matter what the patients need!

And finally, there are practice improvement activities. To fulfill this requirement, I am participating in my state’s controlled substance monitoring program. I have to access the state PDMP website now every time I prescribe a narcotic or benzodiazepine. Of course, they couldn’t have made the website more unwieldy. I have timed it, and it takes about a minute and a half to look up each patient — time I don’t have.

There cannot be value until patients have affordable access to the care they need. There cannot be value until doctors can get patients the care they need without having to jump through massive hoops; until there are EMRs that actually deliver on their promise rather than make life miserable for doctors and their patients; until we have some transparency regarding the monetary value of our patients’ care; until the layer upon layer of useless, excessive, wasteful rules and administrative hassles are wiped away. Then, and only then, can we begin to work on value.

Matthew Hahn is a family physician who blogs at his self-titled site, Matthew Hahn, MD.  He is the author of Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform.

Image credit: Shutterstock.com

Prev

A meditation in medical school

November 12, 2017 Kevin 0
…
Next

Want a simple and easy-to-use EMR? Well, you can have it for free.

November 13, 2017 Kevin 3
…

Tagged as: Medicare, Public Health & Policy, Washington Watch

Post navigation

< Previous Post
A meditation in medical school
Next Post >
Want a simple and easy-to-use EMR? Well, you can have it for free.

More by Matthew Hahn, MD

  • This doctor got COVID. Here’s what it taught him.

    Matthew Hahn, MD
  • These leaders will not fix health care

    Matthew Hahn, MD
  • The demonization of socialized medicine

    Matthew Hahn, MD

Related Posts

  • Instead of Medicare for all, how about Medicare for more?

    Brian C. Joondeph, MD
  • Doctors must take a stand and force the government to cancel MACRA

    Matthew Hahn, MD
  • Expensive Medicare patients aren’t who you think

    Peter Ubel, MD
  • Why this physician supports Medicare for all

    Thad Salmon, MD
  • The conservative appeal of Medicare for all

    Peter Ubel, MD
  • Is this cost-saving Medicare proposal doomed?

    Martha Rosenberg

More in Policy

  • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

    Ton La, Jr., MD, JD
  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

    Robert Pearl, MD
  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions
    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 13 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • New Data in NSCLC Bolster Support for Perioperative Immunotherapy
  • Breathing Support Type Matters for Preventing Extubation Failure in the PICU
  • Second-Line Axi-Cel Bests Standard in Relapsed/Refractory Large B-Cell Lymphoma
  • New Agents for Relapsed/Refractory Myeloma Impress in Early-Stage Clinical Trials
  • Kratom Linked to Outsized Proarrhythmic Risks

Meeting Coverage

  • New Data in NSCLC Bolster Support for Perioperative Immunotherapy
  • Second-Line Axi-Cel Bests Standard in Relapsed/Refractory Large B-Cell Lymphoma
  • New Agents for Relapsed/Refractory Myeloma Impress in Early-Stage Clinical Trials
  • CAR-T Tops Standard Care in Heavily Pretreated Lenalidomide-Refractory Myeloma
  • T-DXd Proves Mettle in Multiple Solid Tumors
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions
    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

If Medicare wants value, it should cancel MACRA
13 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...