December 2, 2016
Dr. Patrick Conway, M.D.
Deputy Administrator for Innovation and Quality and Chief Medical Officer Department of Health and Medicaid Services
L 7500 Security Blvd L
Windsor Mill, MD 21244-1849
We are writing to thank you for meeting with us today and memorialize our MIPS proposal and concerns surrounding big data. Most doctors agree that MACRA/MIPS is not in the best interest F of patients, or the greater physician community. It is expensive, intrusive, time consuming, and interferes with the sanctity of the patient-doctor relationship. Furthermore, it does nothing to enhance the quality of care we deliver, despite its intent.
Big data is one of the most concerning consequences resulting from this regulation. The culture that has developed around the belief that quality can be quantified by the government is chilling. Quality is not quantifiable by any uninvolved third party. It is a matter determined only by the patient. “Quantity has a quality all its own,” falsely attributed to Stalin is still a key tenet of the theory of Marxist dialectical materialism.
It is our sincere hope that as a result of our meeting today, and the input and feedback you have previously received from the physician community, you will consider providing a complete exemption for small and rural practices.
The investment of time and money in an attempt to comply with MIPS regulation is not compatible with these practices staying in business, which will leave many patients without their doctor and further limit their healthcare choices. In addition to such an extended exemption, we propose a new implementation process that allows physicians freedom of choice.
Under this proposal, those physicians who want to work with the Quality Payment Program should be free to do so. Separately, those physicians who voluntarily agree to take a 10 percent cut in Medicare allowable charges would make dollars available for the bonuses earned by willing participants. Those doctors will post their retail prices for E&M codes and be able to bill their Medicare patients (who agree) the balance of the amount due. We call this MIPS Choice.
Because of the potential challenge imposed by big data, we plan to lobby Congress to pass legislation that will restrict the exchange of patient data and what we feel is a direct intrusion into our patient’s private lives. We will also ask for legislation that allows physicians to privately contract.
We need your help in bringing price transparency to the hospital marketplace. If a proposal such as MIPS Choice were to be offered, we would anticipate that the marketplace will begin to demand transparency in physician offices.
We hope to leave our meeting today with your commitment to consider our suggestions as part of the final rule that will be published later this month. It is our hope that this is the first of many conversations that ultimately result in more patient choice, lower costs and legitimate higher quality healthcare and medical care opportunities for our patients.
Marcy Zwelling-Aamot, MD FACEP Co-Chairwoman
John Gill, MD Co-Chairman