Tags: Doc Fix Bill | HR2 | HHS | Medicare

'Doc Fix' Bill Undermines Quality Healthcare

Monday, 13 April 2015 03:32 PM Current | Bio | Archive

The so-called Doc Fix bill was on its way to rapid passage by Congress, and a presidential signature was promised. Fortunately, the lure of Panama Beach was too strong for the World’s Greatest Deliberative Body. The Senate took a pass and adjourned for Spring Break.

This gives the American people a rare opportunity to actually read the bill and see what’s in it before it is passed into law. Not surprisingly, HR2 is a disaster that should never have been brought to a vote in a Republican-controlled House. Needless to say, it passed by a wide margin, and will almost certainly sail through the Senate. This is sausage constructed behind close doors by Boehner/Pelosi, with input from crony capitalists, not practicing physicians or patients.

As I have previously written, SGR repeal was never necessary, since the pay cuts to doctors were blocked almost every year since the law was passed. Congress knows that a 20 percent rate cut on the already-low Medicare doctor payments would force large numbers of doctors out of Medicare participation. The meaningless SGR repeal was used as a foil to facilitate passage of a bill that consolidates central control of medical practice.

What’s actually in HR2? Kudos to my friend and colleague, Dr. Kristin Held, who had the intestinal fortitude to slog through the bill over a painful weekend (her analysis here). According to Dr. Held, the HR2 fixes doctors in the veterinary sense of the word: “The Doc Fix neuters the profession of medicine and transforms us from healers to heelers getting paid by doing exactly what HHS Secretary says.”

You know from my previous posts that HHS and others want to do away with the fee-for-service payment system. Section 101 (e) of HR2 promotes Alternative Payment Models.

It creates more bureaucracy, setting up the Physician-Focused Payment Model Technical Advisory Committee, which by November 2016 “shall establish criteria for physician payment models, including specialist physicians (Sec.101 (e)(2)) and establish incentive payments for participating in such models (z).” Money will no longer be paid to physicians, only to Eligible Alternative Payment Entities (i.e., Accountable Care Organizations, medical “homes”).

A Merit-Based Incentive Program will replace the current EHR Meaningful Use and Physician Quality Reporting System penalties. Physicians will be given a Composite Performance Score which will be posted publicly on The Physician Compare site on the CMS website, and is based on “quality,” resource use (i.e., cost), “clinical practice improvement,” and “meaningful use” of the electronic health record (i.e., reporting clinical data).

Health IT lobbying clearly is effective. The American Board of Internal Medicine is also lobbying to have its onerous and costly Maintenance of Certification process included as the key “practice improvement” criterion.

Physicians with a top performance score may be "rewarded" with a 0.5 percent annual fee update. Pop the champagne! Medicare Advantage plans somehow managed to get a 1.5 percent annual update. These plans will be subject to quality reporting as of 2016.

By 2021, the Medicare incentive plan is to be expanded to include private insurance. This is the “Combination All-Payer and Medicare Payment Threshold Option.” HHS Secretary Sylvia Burwell said as much in a recent public appearance. Starting to resemble a complete federal takeover of medicine, isn’t it?

Physician participation in Medicare is not (yet) mandatory. Doctors can and should opt out of Medicare, and go back to billing patients directly for their services. But will we be allowed this option?

Section 507(4) requires a valid NPI (National Provider Identifier) number on pharmacy claims and gives the HHS Secretary power to determine whose NPI is valid. Without a valid NPI, a doctor will be unable to prescribe medications, order labs, and/or imaging studies. In other words, he will not be able to practice medicine.

A real Republican Senate would not allow HR2 to get a vote. But the Doc Fix is in. Sen. Mitch McConnell, R.-Ky., will whisk it through, and Obama will happily sign it — which should tell you something.

For the one-third of physicians still in private practice, you have a choice. If enough of us opt out, we can save individualized medical care. If only a handful do, I’m afraid it’s game over.

Since 1990, Dr. Amerling has been on staff at the Beth Israel Medical Center (now Mount Sinai Beth Israel) in New York. He served as director of Outpatient Dialysis from 1995-2012. Amerling is board certified by the American Board of Internal Medicine for Internal Medicine and Nephrology. He also is president of the Association of American Physicians and Surgeons. He has been published in many journals. For more of his reports,
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HR2 fixes doctors in the veterinary sense of the word.
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Monday, 13 April 2015 03:32 PM
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