Stupid and Stupider: The SGR “Doc Fix”- Starring The House and The Doctors

Infamous MIT economist Jonathan Gruber, PhD worked intimately with fellow Obamacare architects to intentionally make the law tortuously difficult to understand in order to get it passed at any cost. In Gruber’s own words, the law was designed to take advantage of the “stupidity of the American people.”

Translation: they deliberately deceived us, and we were easily duped.

We fell for the tricks and lies like Eve for the Forbidden Fruit. Now, we live outside the garden of legislative honesty and integrity under the harsh new reality of the paradoxically named Affordable Care Act. Reality proves the promises were false. You can’t keep your health plan, you can’t keep your doctor, your premiums and deductibles are skyrocketing, as are your denials and restrictions, and it costs incalculably more than “not one dime” in new taxes. Will we ever learn?

We, those of us in working the medical trenches, know first hand that Obamacare is deeply flawed and unworkable. They, those who deny this, admit it in their ongoing propaganda efforts to deceive us about how well the law is playing out and their nonstop unilateral, if not unconstitutional, administrative changes to the law.

Yes, it has boiled down to “We vs. They” – We, the People, vs. They, who want to fundamentally transform the confidential patient-physician relationship, defile the sacred Hippocratic Oath, and take 100% control of every medical dollar and decision in the ultimate game of life and death.

Their game plan is predictable, replete with end-arounds, trick plays, thrown games, and house rules. Their strategy is irrational. They ignore real solutions offered by actual doctors and instead contrive unproven systems offered by partisan ideological bureaucrats. They passed it, without reading it, so we could see what’s in it. But do we see? Have we looked this time? Or are we really just stupid?

The march toward single-payer medicine progressed from a marathon to a sprint on March 26th when the House of Representatives passed H.R.2 the fatefully named “Doc Fix” or “SGR” bill, with overwhelming bipartisan support. Boehner and his Republican House rejoiced and gloated as President Obama and Nancy Pelosi beamed and smirked. President Obama is “looking forward to signing a good bill in this area” according to White House chief economist Jason Furman who touts that “the SGR is going to offer us even more tools to expand the same types of new payment models that we put in place in the Affordable Care Act.” I read it, and I agree. The “Doc Fix” is Obamacare on steroids and amphetamines.

Fortuitously, the day the “Doc Fix” passed the House, I was on Capitol Hill as a member of the National Physician Council on Health Care Policy and the National Physicians Coalition for Freedom in Medicine to present a patient-centered rescue and reform solution for legislators to consider in anticipation of the Supreme Court ruling in the King vs. Burwell case in June. My friend, Dr. Z, a physician leader and patient-loving colleague who has fought with me for patients in this government war on Hippocratic medicine, was crying. I discovered that there had been significant compromises and add-ons to the “Doc Fix bill, “ but that now it would pass. I cried for the first time in this six-year assault on the American patient, violated and betrayed. I downloaded the bill and read it, knowing the hard call I must make.

The hyped SGR fix is a hoax, a diversion to distract my fellow physicians from the meat of the bill that forever puts a stake in the heart of the patient-physician relationship. The SGR fix becomes irrelevant when the “Alternative Payment Models” put forth in the bill go into effect. It’s frightening to realize that my gullible colleagues would embrace such radically transformational healthcare law without reading or understanding it. What if they approached medical literature in this fashion? Or what if there’s no limit to what they’ll do to keep getting their check from CMS? Is Hippocrates dead by the hand that bears the pen that signs his check?

The Doc Fix neuters the profession of medicine and transforms us from healers to heelers getting paid by doing exactly what HHS Secretary says, “Mother May I?”- doctor edition. Before you castigate me, read it yourself.

  1. 101 (e) Promoting Alternative Payment Models. – This section warrants intent scrutiny. Six months after the law is enacted, an 11 member Committee (the Physician-Focused Payment Model Technical Advisory Committee) is appointed by the Comptroller General of the United States. Physicians who accept Medicare will be paid not for the services they provide but by new, unproven Alternative Payment Models. The Secretary shall fund the committee with $5,000,000 per year starting 2015 and each subsequent year with money taken for Medicare. By November 1,2016, the Secretary shall establish criteria for physician payment models, including specialist physicians (Sec.101 (e)(2)) and establish incentive payments for participating in such models (z) based on care episode and patient condition codes and classification codes where payment is made to “an eligible alternative payment entity” (no longer directly to the doctor) in a lump sum on an annual basis on a capitated basis, and “The Secretary shall establish policies to implement this…”

By 2021 and 2022 this Medicare incentive plan is expanded to include the (ii) Combination All-Payer and Medicare Payment Threshold Option. Translation: all 3rd party payers, including all private insurance, is included in the government run alternative payment model. (The VA is excluded). In order to be paid: 1.the money can only go to eligible alternative payment entities, not individual physicians. 2. Money will only be paid to entities that a.) collect patient data and do required reporting on performance category measures determined ultimately by the HHS Secretary, b.)use HHS Secretary certified Electronic Health Records (EHR) technology, and c.) the eligible professional(physician) participates in an entity that is a medical home, or “bears more than nominal financial risk” if actual expenses exceed expected expenses. The Secretary herself determines whether an eligible professional (Obamacare Newspeak for physician and inclusive of everyone from a midwife to dietician by 2017) is a qualifying Alternative Payment Model participant “as the Secretary determines appropriate.”

  1. Money will not be paid to individual physicians-only to Eligible Alternative Payment Entities who are required to use HHS certified EHR technology, pays only for services based on Secretary’s quality measures, or is a Medical Home (1115A(c)). Further government control is found Per (4): There is no administrative or judicial review for any of this.
  2. Not later than July 1,2016, HHS Secretary will apply all this to Medicare Advantage.
  3. A Merit-Based Incentive Program will replace the current EHR Meaningful Use and PQRS penalties. Physicians will be given a Composite Performance Score from 0-100, which will be posted publically on The Physician Compare site on the CMS website, and is based on the following:


2.Resource Use 30%

3.Clinical Practice Improvement 15% (Newspeak new word for MOC)

4.Meaningful Use EHR 25%

The HHS Sec will have final say on measures and scoring, so it all boils down to who complies with her requirements and implements them to her satisfaction.

A physician (now lumped in as “Eligible Professional”) who does not do what the Secretary requires, including completely surrendering the private patient medical records to her, scores a 0 and a horrible public listing.

A physician (eligible professional) who totally complies and does everything the Secretary says, gets a 100 and a great public score on the Physician Compare website.

Based on this score, doctors are given what the Secretary determines as their “payment adjustment factor.” It can be positive, 0, or negative. A doctor can receive up to a 10% bonus for doing everything the HHS Secretary says. While the supporters of the “Doc Fix “ proclaim that it takes away penalties, is a “Negative payment adjustment factor” and a humiliating public listing for not following government marching orders NOT A PENALTY?

This is undeniably the fast track to single-payer, government –run medicine. Physicians must allow full disclosure of confidential patient information to the government in interoperable Electronic Health Records. HHS can then sell this data on Medicare patients to Qualified Data Entities. Soon this will include Medicaid, SCHIP, and private insurance patients as well. Authorized users of this data who will have full access to patients’ private medical records are: a provider of services, a supplier, an employer, a health insurance issuer, a medical society or hospital association, or any entity that is approved by the Secretary, as determined by the Secretary.

This Doc Fix is something I cannot ethically comply with. I will not violate the Hippocratic Oath I took nor the confidentiality and sanctity of thousands of patient-physician relationships I have been engaged in for the past 25 years. This I will not do, and government cannot compel my services nor force me to do it.

Thus, if the Senate passes this bill in this form, I will opt out of Medicare on October 1, 2015. Each physician must make this decision for him or herself. Our great tradition of innovative, pioneering, and life–saving medicine based on sound, proven, peer-reviewed, and published scientific data cannot be replaced by untested, unproven models based on ICD10 billing data and reporting on interoperable EHR that doesn’t even exist as mandated by a non-medical, political, partisan, appointed bureaucrat HHS Secretary. I will not betray my patients or profession in the fashion that our elected officials have betrayed us by irresponsibly passing laws they haven’t read, that they change on a whim, that waste money and lives, and destroy our blessing of liberty.

The politicians sold out to the specialty hospital lobbyists and IT. What will doctors do?

The Doc Fix goes further to seal our fate and end the private practice of medicine in America as we know it. In anticipation of physicians like me choosing patients and principle over money and politics, the “Doc Fix “ adds Section 507(4) which requires that a valid NPI (National Provider Identifier) is required on pharmacy claims and then gives the HHS Secretary power to determine whose NPI is valid. This bill effectively gives the HHS Secretary the power to selectively validate or invalidate a physician’s ability to prescribe medications for Medicare patients, and all patients soon as the features of this bill set in. So, if I like my patients, I can’t keep my patients.

I remain stunned that this bill was supported and passed by physician Congressmen and those who were elected on their pledge to repeal Obamacare. Haven’t they learned? Didn’t they read it to see what was in it? Did they just sell us out? Or are they just stupid?

And our physician groups that are aggressively supporting this? And individual physicians blindly in support? We must fight this government takeover of our profession for the sake of humanity, the sick, suffering, frail, disabled, premature, elderly… the weakest of us all, our fellow man, and our patients. We’re the last bastions of hope. By God, we need doctors of character and courage back in the game. America’s doctors are being used as pawns if not weapons. If we do not resist, we are to blame. The “Doc Fix” is a call for any physician with a mind, conscience, or regard for the patient and Hippocratic oath to opt out of Medicare. My contemporaries are weak, easily intimidated, easily duped, and most easily bribed.

And sadly, apparently, we’re just stupider. Gruber was right. Stupid and Stupider


4 thoughts on “Stupid and Stupider: The SGR “Doc Fix”- Starring The House and The Doctors

  1. Thank you for diligent work reviewing SGR. This proposal is so radical and threatens to destroy medicine and severely curtail doctors with untested bureaucratic methodologies that have no data or evidence based practice to back it up. It is a recipe for disaster and I believe it will force doctors out of medicare and ultimately out of private insurance coverage of medical and surgical treatments. I am horrified at the proposals mentioned in your editorial and will contact my senators on Monday.

  2. Pingback: Stupid and Stupider: The SGR “Doc Fix”- Starring The House and The Doctors | krisheldmd | THE SOVEREIGN PATIENT

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