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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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