MACRA is bribery, extortion and a patient privacy killer, doctor says

Kristen Held, MD, cautioned that physicians cannot ethically comply with the rule as it stands today and predicted that many will opt out of Medicare because of it. 
By Beth Jones Sanborn
12:05 PM

The Medicare Access and CHIP Reauthorization Act is already drawing fire from caregivers and clinicians.

One such doctor is speaking out against what she perceives as the potential gross invasions to patient privacy and negative impact to many practices and solo providers that MACRA will bring.

"Private physicians cannot ethically comply with MACRA," Kristen Held, MD, wrote in the Journal of American Physicians and Surgeons. "If this rule goes forward as promulgated, many more physicians will opt out of Medicare and commercial insurance."



[Also: MACRA: IT shops can help providers thrive under the new payment model]

The rule, set to be finalized in November, replaces the Sustainable Growth Rate with a new system whereby providers are judged by a set a quality measures within MACRA's Quality Payment Program. Reimbursement rates, bonuses, and penalties will be based on data reported by providers under the program.

Held also slammed the scoring guide, writing that "scoring and grading physicians through financial incentives and penalties in order to drive behavior would, in other contexts, be called bribery and extortion."

Held further defended the interests of small practices, pointing out that CMS projected a large number of solo practitioners and small practices will receive a "negative payment adjustment" and because the payment adjustments are budget neutral, shifting income from those who score poorly to those who do well, by 2022, the gap is projected to reach 19 percent.

MACRA replaces threatened SGR pay cuts, which were always postponed, with certain pay cuts for those who put patients ahead of system satisfaction, Held said.

She also attacked the pending legislation for creating the need for costly technological improvements and, in her view, essentially putting an end to privacy.

Participation mandates costly Certified Electronic Health Record Technology (CEHRT), and she highlighted the fact that physicians are required to certify to CMS that they will cooperate with the Office of the National Coordinator for Health Information Technology surveillance and, in so doing, not block government access to their practice's EMR's, including patients' individually identifiable health information, stressing that CMS could require access to 10 or more years worth of a patients' information without prior consent.

Roughly 4,000 formal comments about the proposed rule have been filed and CMS continues to seek feedback.

In recent months, in fact, CMS Acting Administrator Andy Slavitt has twice hinted that a delay in the implementation of the law could be possible, largely for the sake of small practices that need more time to prepare.

Twitter: @BethJSanborn

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