Your Voice: MACRA will fail... and here's why

The Medicare Access and CHIP Reauthorization Act, known as MACRA, is a 2,398-page set of new and complex regulations introducing changes in how physicians will deliver healthcare and how they will be paid by CMS. 

The last thing doctors need is another set of distracting bureaucratic measures to be satisfied before we can attend directly to the patient’s needs. CMS is rushing to implement MACRA, despite the heavy burden this will place on physicians and their patients. MACRA will supposedly improve the quality of medical care while decreasing its cost and increasing the amount of information that doctors collect from their patients and report to CMS. 

MACRA will, inevitably, fail on all counts: It will increase the cost of medical care, degrade the quality of care and it will clog patient charts with even more of the useless and distracting “junk” information that already litters patient charts and records, due to prior mandates by CMS. 

CMS can save American physicians (and their patients) a great deal of stress and expense by postponing the implementation of MACRA and reopening the question of whether it is needed at all. 

Physicians were only given 60 days to read and comment on MACRA, which would require them to read 40 pages of dense regulations per night every night for 2 months, on top of the typical doctor’s 10-plus hour workday. That would leave one evening to figure out the adverse effects of MACRA and write a letter of complaint to CMS, which would be thoroughly ignored there.

Traditional fee-for-service Medicare provides excellent medical care and is preferred by both patients and by their doctors. The 2,398 pages of new regulations in MACRA cannot and will not decrease the cost of medical care, it will just substitute hours of useless computer data entry for the actual clinical care that patients need and doctors want to provide. 

Let me mention that doctors are angry and frustrated by the amount of data we are forced to type into computers each day; useless data required by CMS. Medicine is the only industry that has ever experienced a large and permanent reduction in efficiency due to the introduction of computers. 

Lastly, physicians should lead any government agency that regulates how physicians practice medicine. That means the top responsible decision makers should be medical doctors, not lawyers or MBA holders. That should go without saying, as should the certainty that 2,398 pages of new regulations will not and cannot lower the cost of medical care, nor can the quality of medical care be improved by forcing doctors to adhere to a uniform template of care instead of providing the individualized care optimal for each individual. 

David L. Keller, MD, FACP

Lomita, California

Next: To enact change, physicians must go public with grievances

To enact change, physicians must go public with grievances

There is no evidence to doubt that government intrusions into medicine have made it almost impossible for doctors to remain independent. Many young doctors just fi nishing training, as well as doctors in practice for years, cannot keep up with the rigors of reporting data and trying to live up to bureaucratic standards that most do not believe in. For that reason, many are joining hospital networks or large medical groups. But even if there were no government interference, I doubt that doctors’ would be any happier. Private insurers are just as intrusive. Things won’t improve for private or employed physicians unless they unite and stage peaceful public protests. Discussions with insurers and government offi cials will not work as they have not worked in the past. Until physicians bring their grievances to the public arena and get public opinion on their side, doctors’ dissatisfaction with the practice of medicine and their inability to “keep up” with the numerous regulations imposed on them will continue.

Edward Volpintesta, MD

Bethel, Connecticut