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The Inbox: Physician Deliberations on MACRA : Page 2 of 4

The Inbox: Physician Deliberations on MACRA : Page 2 of 4

Dana writes: As a physician who started a private practice only one year ago, I'm becoming more and more concerned about the increasing federal legislation that dictates care. I feel as if government is trying to force me, as it has my predecessors, to join large group such as ACO's. These have already been proven ineffective, almost as ineffectual as the expensive EHR that now bogs down my practice and takes part of my daily profits from billing for its use. But like this I have little choice. In fact, I notice that government reimbursement pays little heed to growing physician expenses such as high student loan debt, malpractice insurance, and god forbid a lawsuit. We are expected to do more with less to keep government happy, all while giving patients less. Less time with the patient, and now less workup in order to avoid a payment penalty. …

Paul comments: This is just another nail in the coffin of independent solo/small group primary care. Have EHRs and meaningful use helped make me practice better — minimally. Try telling an 85 year old they need to sign up on the internet for a patient portal, so they can send me secure messages! MACRA is just another smoke and mirrors attempt by the government to make it appear they are improving healthcare. Want to improve healthcare — mandate to insurers to stay out of my office and stop telling me how to practice medicine and to cover tests when I deem them needed and cover prescriptions when I think it's in the best interest of the patient to have them prescribed. Stop the endless "request for diagnosis validation — that only benefits the insurers yet my staff and I do all the work. This bean counting, check the box exercise is likely to force more solo and small practices out of business — let the masses have their assembly line medicine I am working longer and harder with sicker patients and getting paid less and less — trust me — if patients didn't feel I was giving them quality service — they would go elsewhere.

Small Practice Doc Speaks Out Against MACRA

The proposed rule is less than a week old but Linda Girgis, a family medicine physician in South River, N.J., is not too pleased with the Medicare Access and Summary CHIP Reauthorization Act of 2015 (MACRA). If CMS' own projections are accurate, in two-and-a-half years, she'll be joined in her dissent by many other small practice docs across the country. By next year, MACRA will change the way physicians are reimbursed for Medicare, combining and configuring the Physician Quality Reporting System (PQRS), the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program (Meaningful Use).

Physicians Practice: You have not been shy in your criticisms of MACRA, what are your biggest problems with the proposal?

Linda Girgis: It's penalizing small practices and solo doctors. It was supposed to be based on quality initiatives, and [CMS] has already revealed how many bonuses they're going to give, how many negative adjustments. I thought this was supposed to be about quality, but it's obviously about balancing their budget rather than improving quality healthcare.

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