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Reimbursement Feature

Courtesy of Professor Stephen Soumerai

Harvard Prof Slams MACRA as “$15 Billion Boondoggle”

Robin Young • Tue, July 11th, 2017

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Stephen B. Soumerai, Sc.D., Professor of Population Medicine at Harvard Medical School, slammed Centers for Medicare and Medicaid Services’ (CMS) recent announcements in The Federal Register and fact sheet about the Medicare Access and CHIP Reauthorization (MACRA) program.

This is the program that was supposed to improve health care quality and improve costs.

According to Professor Soumerai it does neither.

In fact, he said, the whole depressing enterprise is nothing more than a $15 billion boondoggle.

“CMS’ announcements in The Federal Register and “fact sheet” are incomprehensible gobbledygook that will be understood by neither doctors, patients, nor the rest of society. The language personifies the complexity, unwieldiness and confused thinking in this huge national policy.”

Please Dr. Soumerai, tell us what you really think.

“MACRA is a $15 billion boondoggle that the best research shows will neither improve quality nor control costs. Paying doctors for quality (e.g., doing a blood pressure exam) or efficiency may make sense theoretically, but it doesn’t work. Rather than making a dent in the continuing upward spiral of healthcare costs in America, it can even result in some doctors avoiding sicker patients because it affects their quality scores and income.”

“Early, poorly designed research suggested that paying for health or cost savings was effective, but these research designs did not account for already occurring improvements in medical practice that the policymakers took credit for. Decades of stronger, well-controlled research debunked these early findings and conclusively showed no effects of these economic policies.”

Actually, we have to agree with Soumerai on that.

Physicians fight every day with insurance companies to align reimbursement with legitimate medical needs of their patients. They know that the most powerful and enduring cost and quality improvements have come from the bottom up. Not from CMS.

Abuse of Doctors

“Currently, we are abusing primary care doctors on the front line with dozens of bureaucratic penalties and regulatory policies aimed at improving their performance.”

“We spend about one-fifth of our gross domestic product on medical care. If anything, this cost is accelerating since 2000.”

“It is time to stop the nitpicking, band-aid regulatory policies that are driving doctors crazy without reducing costs or improving quality. It is essential to work towards the achievement of a new system of care that covers the entire population and costs less. Neither Obamacare nor any Republican plan can accomplish this worthwhile goal.”

Drawing and Quartering MACRA

Soumerai was not finished.

“A large cadre of influential economists have convinced the government that money is the only driver of quality and efficiency. Nothing could be further from the truth. Many factors affect measures of quality and cost savings. These include: Social problems and lack of supports are root causes of poor health outcomes. These include poverty, language barriers, spousal abuse, drug abuse, rurality, early manifestations of dementia and many more. These factors are usually not measured by Medicare.”

“Further, doctors do not prescribe antibiotic medications to patients who are allergic to them even if they are promoted in a quality measure.”

“Similarly, after the ACA [Affordable Care Act] required CMS to penalize hospitals for hospital-acquired infections, studies showed that some doctors were simply altering codes to make it appear that the patient was admitted with the infection.”

“When a better CDC [Centers for Disease Control and Prevention] dataset was used instead of “doctored” Medicare claims, this study showed no effect of the penalties on infection rates.”

“Why should Doctors only respond to financial incentives when thousands of studies have shown that opinion leaders, knowledge, clinical skills, patient demands and many other non-monetary factors all influence quality of care?”

“Perhaps the biggest reason for this giant boondoggle is the unflinching confidence in economic theories and models that lack a shred of evidence. Even pay-for-value and alternative quality contract policies lack any evidence that support programs like MACRA.”

Soumerai for President!

We start organizing next week.

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