Feared Dr. Halamka jumped the shark re MACRA. But, CMS intro proves MACRA is crazy on steroids complex proposal aimed at "simplification" and easing MD burden, not driving them out.
Corporate metrics mavens and clinicians (and bipartisan Congressional lobbyists) created acronyms and lingo (QPs, MIPS, APMs) to explain obtuse rules and calculations...Andy Slavitt's (ex- United Healthcare, now CMS exec) footprint. Dear Andy “Are you serious?”
On other hand, MDs as a group have been self-centered for decades, late in grasping they too are part of corporate healthcare / America. MDs lack aggression in patient safety/ HAIs;many still deny stats and their role. AHA fought - even belittled - RNs expanded practice, even with proof of efficacy. Few MDs fight RN layoffs used to boost profits even when quality of care impact known. Now MDs wonder why many not sympathetic.
While many are dedicated, their image is "focus is income". Now, like other employed professionals, they experience KPI games, stagnant wages, job loss, unrealistic/unsafe productivity goals, and lack of respect. Welcome to RNs' world.
Physicians - (sorry Meltoots). They have been there own worst enemy since the start of Medicare.
First in 1965 they (via AMA) fought Congress to kill Medicare, then when Congress gave in and agreed to create Part B so docs could 'do there own thing' and be a separate part of a loose health care delivery system they jumped on the band wagon. Medicare Part B made many specialty docs millionaires (but not the primary care givers).
Docs loved it - manna from heaven from 1966 to today. But one thing AMA forgot to tell its membership is that when you go to bed with the 'devil' you wake up in hell.
On top of that the AMA has promoted the "Markus Welby" image for decades when the fact is most docs make educated guesses every day, and now that image is cracking - both at a patient level (consumer driven healthcare) and at a payment level (government).
meltoots - 8 years ago
Saddens me to see that 30% are victim blaming the physicians in this poll. I"m guessing they are not physicians. Or see us as whiny. But damn, you have to admit we are literally beaten senseless with constantly changing complex regulatory activity MACRA MIPS AAPM, always looking to penalize us, major insurance hassles always looking not to pay us, large deductibles (can't pay)/ACA, preauthorization nightmares, burden of board cert (MOC, CME requirements), monday morning quarterbacking with RAC audits and clawbacks, MU audits, patient satisfaction, HIPAA, ICD10, and a zillion other non clinical activity that buries us to our necks and everyone grabs a rock and stones us every day. I'm not sure where this is all headed, but its not good. When John Halamka says if we stay on the current path, he says its time to get out the profession, then everyone should stop and listen. He's been a ONC/CMS/Health IT pioneer and contributor. When you put him on the ropes, its a dark day for the future of physician practice in the US. My worry is that no one is really listening. That all the policy wonks and people looking to make their nickel off of my patient care and work, will keep pushing until a crisis occurs, and then it will be too late. It takes 14 years of training just to make a fresh new me. And another 17 of practice experience that is truly invaluable to my abilities as a surgeon. With my low costs and quality numbers (thank you propublica) CMS and ONC should be begging me to stay on board, and not be penalizing me 2% because I cannot do MU. And with MACRA, it looks like they want to ratchet me down 9%. Thats just crazy. Should be the exact opposite. Look at my costs, look at my costs per patient, look at my patients co-morbidities, look at my readmit rate, and tell me I'm a bad deal for CMS. No chance. You don't need me to count numerators, denominators, attest, comply, do ACI or Clin Pract Improv Activities, or Qual counting measures. I am already there. All that is meaningless. Look at my costs and my patients, and their outcomes. Any day, any time. Maybe CMS should look to see if we are regional centers of excellence for private insurers, or Tier one, etc, and say, heck if you are good enough for United Health Care, or Anthem, etc, then you are good enough for CMS.
Feared Dr. Halamka jumped the shark re MACRA. But, CMS intro proves MACRA is crazy on steroids complex proposal aimed at "simplification" and easing MD burden, not driving them out.
Corporate metrics mavens and clinicians (and bipartisan Congressional lobbyists) created acronyms and lingo (QPs, MIPS, APMs) to explain obtuse rules and calculations...Andy Slavitt's (ex- United Healthcare, now CMS exec) footprint. Dear Andy “Are you serious?”
On other hand, MDs as a group have been self-centered for decades, late in grasping they too are part of corporate healthcare / America. MDs lack aggression in patient safety/ HAIs;many still deny stats and their role. AHA fought - even belittled - RNs expanded practice, even with proof of efficacy. Few MDs fight RN layoffs used to boost profits even when quality of care impact known. Now MDs wonder why many not sympathetic.
While many are dedicated, their image is "focus is income". Now, like other employed professionals, they experience KPI games, stagnant wages, job loss, unrealistic/unsafe productivity goals, and lack of respect. Welcome to RNs' world.
Physicians - (sorry Meltoots). They have been there own worst enemy since the start of Medicare.
First in 1965 they (via AMA) fought Congress to kill Medicare, then when Congress gave in and agreed to create Part B so docs could 'do there own thing' and be a separate part of a loose health care delivery system they jumped on the band wagon. Medicare Part B made many specialty docs millionaires (but not the primary care givers).
Docs loved it - manna from heaven from 1966 to today. But one thing AMA forgot to tell its membership is that when you go to bed with the 'devil' you wake up in hell.
On top of that the AMA has promoted the "Markus Welby" image for decades when the fact is most docs make educated guesses every day, and now that image is cracking - both at a patient level (consumer driven healthcare) and at a payment level (government).
Saddens me to see that 30% are victim blaming the physicians in this poll. I"m guessing they are not physicians. Or see us as whiny. But damn, you have to admit we are literally beaten senseless with constantly changing complex regulatory activity MACRA MIPS AAPM, always looking to penalize us, major insurance hassles always looking not to pay us, large deductibles (can't pay)/ACA, preauthorization nightmares, burden of board cert (MOC, CME requirements), monday morning quarterbacking with RAC audits and clawbacks, MU audits, patient satisfaction, HIPAA, ICD10, and a zillion other non clinical activity that buries us to our necks and everyone grabs a rock and stones us every day. I'm not sure where this is all headed, but its not good. When John Halamka says if we stay on the current path, he says its time to get out the profession, then everyone should stop and listen. He's been a ONC/CMS/Health IT pioneer and contributor. When you put him on the ropes, its a dark day for the future of physician practice in the US. My worry is that no one is really listening. That all the policy wonks and people looking to make their nickel off of my patient care and work, will keep pushing until a crisis occurs, and then it will be too late. It takes 14 years of training just to make a fresh new me. And another 17 of practice experience that is truly invaluable to my abilities as a surgeon. With my low costs and quality numbers (thank you propublica) CMS and ONC should be begging me to stay on board, and not be penalizing me 2% because I cannot do MU. And with MACRA, it looks like they want to ratchet me down 9%. Thats just crazy. Should be the exact opposite. Look at my costs, look at my costs per patient, look at my patients co-morbidities, look at my readmit rate, and tell me I'm a bad deal for CMS. No chance. You don't need me to count numerators, denominators, attest, comply, do ACI or Clin Pract Improv Activities, or Qual counting measures. I am already there. All that is meaningless. Look at my costs and my patients, and their outcomes. Any day, any time. Maybe CMS should look to see if we are regional centers of excellence for private insurers, or Tier one, etc, and say, heck if you are good enough for United Health Care, or Anthem, etc, then you are good enough for CMS.