Your Voice: Physician accountability? Let’s legislate Congressional accountability

We know the Medicare Access and CHIP Reauthorization Act (MACRA) and Merit-based Incentive Payment System (MIPS) were designed to grade physicians on a Byzantine curve by big data algorithms, where “passing” physicians get an incentive and “non-passing” physicians don’t get paid. 

It penalizes and discriminates against solo and small physician practices. MACRA’s MIPS will destroy independent physicians who cannot possibly comply with all of the data measures, time, personnel and cost. Individual personalized healthcare will be replaced by a corporate compliance algorithm treatment. It will also create expensive unsustainable big data factories, subject to government and insurance and third-party payers, out of healthcare systems.  

I propose GACRA GIPS (Government Accountability Credibility Realignment Assessment and Government Incentive Payment System instead as law.

We all know the U.S. House and Senate have not done an honest job for the American people in many decades. With GACRA GIPS, if congressmen and congresswomen don’t work, vote, complete their tasks and create a budget that lives within our means well paying down the national debt, they don’t get paid. Further, they must live and work by all the rules that all American citizens do. Furthermore, imprisonment should be mandatory if they don’t comply during a two-year term. 

Through GACRA GIPS we would only have truly interested and motivated people running for office. They would have to live by the promises they made in their districts, state and nationally. We would have a true and honest budget that pays our needs, prioritizes our wants and pays down our national debt. Politicians of all stripes and parties would have to work together or not get paid. 

Call your legislator to repeal MACRA MIPS and replace it with GACRA GIPS. Just dial 202-224-3121.

Craig M. Wax, DO
Mullica Hill, New Jersey

All practices, not just small ones, suffer under MACRA

I agree 300% with your First Take (“CMS should exempt all-not just some-small practices from MACRA,” July 25, 2017), but I would go much farther. As I have argued in prior letters to this publication, and to others, MACRA will be harmful to medicine in every practice, not just the small ones.

While it is true that the small practices will be bankrupted, that will be a mercy for those physicians. Their colleagues at large corporate “charity”-owned practices will have every advantage in the coming cyber-warfare between clinicians to attain higher rankings in MACRA compliance. This means the widespread, uncritical and often inappropriate application of guidelines developed by “thought leaders” in medicine.

I won’t get into details, except to give the example of PSA screening, which every practicing primary care physician and every urologist knows saves lives. Only when intention-totreat analysis is applied to the two extremely poorly-designed and badly-conducted clinical trials that exist could the U.S. Preventative Services Task Force (USPSTF) come up with a “D” recommendation.

In addition to strict, mindless adherence to faulty guidelines, MACRA punishes physicians for “spending too much” in their practices of medicine, despite the fact that a BMJ study showed that higher spending by physicians on testing and treatment is associated with lower risk of malpractice. So, the “lucky” doctors employed by large practices will survive financially, perhaps, at least until they push cost controls too far and deny necessary care to a patient who later sues for malpractice.

Imagine how angry an otherwise healthy man around the age of 50 will be to learn that his prostate cancer would have been curable if his internist had merely ignored the USPSTF recommendation, as did Ben Stiller’s fine physician, and many other top clinicians, often absorbing fines along the way as government retaliation for practicing conscientious medicine.

David L. Keller, MD, FACP
LOMITA, CALIFORNIA