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:

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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