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05/10/2016 Neil H Hecht, DPM
CMS and the Downfall of Western Civilization
CMS has estimated that 85% of small medical practices will be penalized over $350 million dollars with the inception of MIPS/ MACRA/ whatever. We doctors are already sustaining the “2% sequestration” and now must face 4-9% reductions in our reimbursements for professional medical care. This is not news to any of you reading this. To put this in perspective, ONE F-22 Raptor fighter jet costs approximately $137 million dollars (we have only 6 so far, but maybe more to be built-there is some controversy about this) and ONE F-35 Joint Strike Fighter costs about $104 million ( we have 171 so far). So, if my math is correct: $822 million for the F- 22 and $17.784 billion for the F-35. That’s more than $18 BILLION dollars for 177 jet planes. (and, I don’t get to fly on any of them, although that would be very cool!) Now if CMS really wants to save $350 million dollars, there are some other options than MACRA/PQRS/MIPS/WTF. For example: we could just accept across the board reductions in our fees of, say, 10% right now and save all of us the time, expense, and worrisome headaches of attempting to figure out the myriad complexities of these program-mandated reductions. This would allow better future planning for those of us in private practice who pay salaries, rents, and other overhead. Or, we could lobby our government to build 4 fewer jet planes. Or, as apparent as it seems, many of us could simply retire from private medical practice (which is, I believe, the ultimate goal of CMS) or “opt out” of the Medicare program (which is probably not a workable fiscal solution for most of us.) As I understand it, first: we doctors had essentially NO input regarding the inception of any of these CMS-mandated programs, and, second: I have seen NO data that indicates that any of these “quality-improvement” measures have shown any improvement in medical care quality or outcomes. Um, so does that mean that there is really no point to any of these mandated programs or could I be mistaken? So, in the long run, shouldn’t we all be thinking about eliminating CMS mandates altogether? Are “we”, the medical establishment of America, doing anything about this apparent waste of almost $800 million dollars in CMS administrative costs annually. Or, maybe we could build a few more jets…..
Neil H Hecht, DPM, Tarzana, CA
Other messages in this thread:
05/12/2016 Robert Kornfeld, DPM
RE: CMS and the Downfall of Western Civilization (Billie Bondar, DPM)
I have read the recent threads regarding the end of private solo practice, CMS, and the downfall of western civilization, etc. It is patently clear that most of us recognize that what you must put into a medical practice has significantly increased and what you get to take out of it has significantly decreased.
As a 1980 graduate of NYCPM, I have been around long enough to have seen dramatic changes in Medicare and health insurance reimbursements. And these changes have been ongoing for at least 30 years (the first Medicare fee freeze I believe was in 1985). Suffice it to say there has been a spate of new guidelines and administrative requirements imposed on practitioners along with enormous cuts in reimbursements.
Physicians clamber to cooperate with any and all of these impositions on private practice for fear of "not getting paid" or "losing market share" - i.e. your patients will find the next DPM around the corner. This is my opinion and should be taken as such, but ALL of the cooperation doctors give to Medicare and insurance companies comes from fear.
And it is this fear that has fueled the cooperative spirit in medicine. And this cooperative spirit has empowered all of these ever-increasing regulations and guidelines and decreased reimbursements to spiral out of control. In a capitalist system with consistent inflation, how is it that doctors incomes were targeted to be lowered? Everywhere I go, prices consistently rise. When I got my first car, I paid 24 cents a gallon. Now it's $2.50. Is the gas any better? Pizza was 15 cents a slice in my Brooklyn neighborhood. Now it's $2.50. Is the pizza any better?
The home I grew up in cost my father $12,000. That same house today would sell for $250,000 at least. So the way I see it, the gas stations, pizza parlors and real estate developers have not suffered a net dollar decrease in income. But we have. And the only reason this has happened is because doctors let it happen. Remember Nero? How much more fiddling are you going to sit by idly and watch until your ability to earn an income consistent with your education and commitment burns to the ground? None of this could have happened if doctors were not complicit in the process.
Has Congress voted itself a pay cut? We have a government that earns $10,000 a year and spends $100,000,000 a year (this is just to make a point in case anyone gets anal over my figures). But we are no longer entitled to earn superior incomes, completely justified by the level of difficulty it takes to get into school, earn a degree, get trained in a residency and then become responsible for the health and safety of the public.
There's something wrong with this picture. And it is clearly that the enemy is within. This happened to us because we let it happen! Anyone who reads PM News knows that there is a growing cancer among practitioners and that cancer is called futility. Yet, futility only really comes after consistent and repeated attempts over time lead to failure and exhaustion. It seems to me that you all just skipped ahead to futility. If you're going to cooperate, stop complaining. If you want to see change, stop cooperating. It can and will get worse until you stand up and say, "I'm mad as hell and I'm not going to take it anymore".
Robert Kornfeld, DPM, Port Washington, NY
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