I read the entire ACA in 2010, every word of MACRA last year, and the 962 pages of proposed MACRA rules over the last few weeks. The proposed rules are clearly Obama and Co.’s “Hail Mary” to get socialized medicine over the goal line (while we are distracted by a proxy issue of where people should urinate and defecate).
By the 2019 patient seeing/billing year, which determines physicians’ 2021 payment adjustment factors, the proposed rules allow CMS to expand this perverse, totalitarian system to a new “Other Payer Model” that will include Commercial insurance and combine it with Medicare data for the spanky-new “All-Payer System.” The proposed rule preamble informs us of the rule-makers’ effort to “rebrand key terminology”, such as renaming “Meaningful Use EHR”- “Advancing Care Information.” Clearly, the “All-Payer” System is Newspeak for “Single Payer.”
Further, the Orwellian Feds mandate bidirectional, interoperable, unblocked access to all Electronic Health Records and data, including access to individual private and identifiable patient data without patients’ permission “at all relevant times”, or there will be punishment. They will extract and sell data, engage in ongoing surveillance, and do continuous, random cyber as well as onsite audits. They create a whole new breed of intermediaries to do this, such as QCDR’s (qualified clinical data registries) and ONC-ACBs (Office of the National Coordinator for Health Information Technology-Authorized Certification Bodies). They will insert government’s untested practice guidelines. It is worse than ever imagined.
This paragraph, verbatim from the MACRA proposed rules, is chilling, “In addition, we note that ONC has clarified, in consultation with the Office for Civil Rights, that ONC-ACBs engaging in authorized surveillance of certified EHR technology under the ONC Health IT Certification Program meet the definition of a “health oversight agency” in the HIPAA Privacy Rule (45 CFR 164.501), and as such a health care provider is permitted to disclose protected health information (PHI) (without patient authorization and without a business associate agreement) to an ONC-ACB during the limited time necessary for the ONC-ACB to perform the required on-site surveillance of the certified EHR technology (45 CFR 164.512(d)(1)(iii)) (80 FR 62716).” Read that again, slowly and thoughtfully, in the context of the current administration that crafted the rules. In the ultimate irony, the Office for Civil Rights authorizes the violation of “the right of the people to be secure in their persons, houses, papers, and effects against unreasonable searches and seizures…”, otherwise known as Amendment IV. of the Constitution of the United States. Perhaps, this is just part of the friendly “rebranding key terminology” initiative?
The rules are Stalinist at best. By what authority do they do these things?
This is why I opted out of Medicare and all commercial insurance and work solely for my patients creating a system whereby we can practice ethical, Hippocratic medicine that preserves the patient-physician relationship- a paradigm-shifting alternate universe-an underground railroad of medicine of sorts.
All physicians must stand up and refuse to enable the fundamental transformation and demise of American medicine via the MACRA proposed rules. There must be massive resistance and massive public outcry and comment to the rules.
Read and comment now. Please, go to this website, read this letter, share with all physicians and patients, and make comments on the CMS site regarding the intolerable MACRA proposed rules. Act now! http://www.npchcp.org/
Time is of the essence,
Kris Held, M.D.