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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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