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10/11/2017    Ron Freireich, DPM

MedPAC Urges Repealing MIPS

And now a another article discussing the
recommendation by MedPAC to repeal and replace
MIPS. The take away, I believe, from the MedPAC
report is as follows. "The commission proposes
eliminating the current set of MIPS measures and
instead relying on population-based outcome
measures, such as preventing hospital admissions
or patient experience. The proposed outcome
measures would be calculated from claims or
surveys and therefore would not require
burdensome clinician reporting, the report said".

After reading this second article, I then went
onto the APMA website and well as my EMR vendor's
site to see how many webinars were created on
MIPS, not to mention PQRS and Meaningful Use and
could only think of the thousands upon thousands
of hours people put into developing webinars,
lectures, writing papers and developing software
programs to track, as the commission stated,
“burdensome clinician reporting”. What a waste of
time from one’s life now that the commission
proposes eliminating the current set of MIPS
measures. Not to mention all the money that came
from APMA dues and physician’s own pockets to pay
for all of this.

I posted a response to the first article on this
forum in July and part of my response is as

This SHOULD initiate a swift and strong response
from the AMA, APMA, and AOA, and hold someone
accountable for this mess. The physician members
of Congress should also be contacted to
investigate this enormous waste of taxpayer’s

Now almost three months later, still no response
from our national associations, just more and
more webinars on how to meet these meaningless

Ron Freireich, DPM, Cleveland, OH

Other messages in this thread:

10/21/2017    Ron Freireich, DPM

MedPAC Urges Repealing MIPS (Jeffrey Lehrman, DPM)

Thank you for your response Dr. Lehrman, however
you have completely missed the major point of my
posts. I appreciate the timeline of MACRA that
you spelled out, but my posts had nothing to do
with that. Regarding your comment about the time
I spent “crafting” my posts not making a
difference, you’re right, it didn’t because you
failed to even mention the MedPAC report in your
response which is what my posts were all about.

I never mentioned the lack of any medical
association, including APMA not speaking out or
lobbying against MACRA. That is in the past. My
posts had to do with the present, which is
MedPAC’s June, 2017 report to Congress
It was only six short months into MACRA when
MedPAC came out with their report which stated in
part“MIPS as presently designed is unlikely to
help beneficiaries choose clinicians, help
clinicians change practice patterns to improve
value or help the Medicare program reward
clinicians based on value,”.

I’m still shocked that there has been no response
that I know of, to the commission’s report from
any medical association. How much of tax payer’s
money went into creating the 2,398 pages of
MACRA, not to mention, the thousands of hours
that the APMA MACRA Task Force put into educating
its members and the hundreds of hours and money
physicians spent to implement MACRA into their
practices, only to have MedPAC recommend to
repeal and replace MACRA. Doesn't that anger you?

Regarding your recommendation to contact my
Representatives and Senators, that’s my point. A
response regarding this debacle should be much
bigger and come from our national associations,
not from a few individual members who will never
be seen or heard.

In your last paragraph, you state “Now that MACRA
is here” which is ironic because according to
MedPAC it shouldn’t be, you suggest some actions
I can take; however, I’m currently already
meeting all the measures through my EMR system.

Lastly, I do appreciate all that APMA does which
is why I have been a member for the past 30 years
and I do plan on contacting Dr. Deheer as you
suggested. Additionally, I don’t assume that
those who teach others about MACRA approve of it,
but I would assume that at least the members of
the APMA MACRA Task Force after all their time
and effort, if not the entire medical profession,
would demand some answers from Congress who voted
in favor of MACRA.

Ron Freireich, DPM Cleveland, OH

10/19/2017    Jeffrey D. Lehrman, DPM

MedPAC Urges Repealing MIPS (Ron Freireich, DPM)

In my opinion MIPS, which is part of MACRA, is an
unfair, unjust, outrageous program which, in its
current form, does nothing to improve quality of
care, improve outcomes, or decrease cost.

A brief timeline of MACRA: This all started when
Representative Michael Burgess (R-TX) introduced
MACRA into Congress. Your statement that there
was no response from national organizations is

Every medical association I am aware of
(including the ones you listed) spoke out against
it, lobbied against it, and tried to either not
make it happen, or make it more palatable for its
members. In reading your post, it is important to
point out that these efforts happened at this
point in the timeline, prior to directing any
resources or efforts to educating members about
how to tackle the program. Despite these
efforts, MACRA passed the House 392-37. It then
passed in the Senate 92-8. You can see it enjoyed
overwhelming bipartisan support.

Once it passed Congress and was signed into law,
CMS was tasked with carrying it out. Your post
suggested that “someone” be held accountable.
I share the above information to make it clear
who is accountable. It has nothing to do with the
President, the Secretary of HHS, or CMS. The only
ones accountable are Representative Burgess and
all those who voted in favor of it. They are also
the only ones that can do anything about it.
Your Representatives and Senators.

If you want to contact your Representatives and
Senators, APMA has made this incredibly easy for
you. You mentioned APMA dues. Since you want to
act, you will be happy to know that your APMA
membership dues have gone towards making that
incredibly easy for you. Instead of doing
Internet searches and clicking around or pushing
lots of buttons on the phone, APMA has developed
a web page that allows you to contact your
congress people with just one click. That web
page can be found here:
aspx When you are logged in, it knows what state
you are in and directs your messages to your
state’s congress people. It is a wonderful tool.
Please use it to share your feelings with your
congress people.

But there is more you can do. I admire your
passion and desire to make a difference. We need
more people like you! The APMA has a legislative
committee. I could be wrong, but I am pretty sure
they are always interested in volunteers who are
passionate and have ideas about how things could
be better like yourself. The chair is Dr. Patrick
Deheer and he is awesome. I don’t want to speak
for him, but I’m pretty sure they appreciate all
those who want to pitch in. Contact info is on
the website I listed above. Your help really
would be appreciated.

In the time you spent crafting your post and the
other one you referenced, you could have put
effort towards something that had a chance of
making a difference.

Getting back to our timeline, after MACRA passed,
and not until after it passed, APMA realized that
members were going to need help. They then
shifted their MACRA efforts from advocacy to
education (They still are doing plenty of
advocating for other things...successfully!).
The order in which this took place is important
in addressing what you wrote. APMA did not choose
to educate instead of fight. They chose to
educate after fighting failed and MACRA passed.

The APMA MACRA Task Force was then formed. A
bunch of APMA members volunteered to serve. This
group of people battled through the ridiculous
2,398 page MACRA final rule (some of us multiple
times!) to attempt to translate it into English
so that we could educate APMA members. We then
spent the thousands of hours you referred to (not
each of us, but maybe collectively) to put
together the webinars, documents, articles,
lectures, and all the other content available to
members that you referred to in your post.

Now that MACRA is here, there are a couple
actions you can take. You can do nothing and
have a very low publicly reported score and take
a 4% Medcare hit in 2019. I do not advise doing
this because it is super easy to perform well in
2017. You can learn how here: You can read the 2,398 page
final rule and figure it out yourself. I don’t
advise this because we already did it for you and
provided you with all the information you need.
You can complain about it, but that doesn’t
accomplish anything. And nobody likes
complaining. You could hire a consultant to help
you, but that’s really expensive and your APMA
membership provides you with access to all the
information you need to succeed. While doing any
of the above you can fight it by contacting
congresspeople as I suggested above. You could
change professions. But everyone has something
they don’t like about their job. Grass is always
greener kind of thing. I can’t think of any other
good options. Regardless of which route you
choose for yourself, please do not assume that
those who teach others about MACRA approve of it.

Jeffrey D. Lehrman, DPM, APMA MACRA Task Force