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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 follows….
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 money. Now almost three months later, still no response from our national associations, just more and more webinars on how to meet these meaningless measures. 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 incorrect.
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: http://apmaeadvocacy.org/SitePages/StateAdvocacy. 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: www.apma.org/macra. 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
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