Comments to CMS on proposed MACRA rule: My Daily Dissent

Sunday, May 22, 2016

Dear CMS Acting Administrator Andy Slavitt,

Thank you for the opportunity to voice my dissent regarding the proposed rule spawned from MACRA by the Center for Medicare and Medicaid Services and published in The Federal Register on 05/09/2016. I have read the ACA, MACRA, and MACRA proposed rule. Because the rule is extensive, my dissent is accordingly substantial. To be complete, my comments will be submitted in a series of submissions, my daily dissent, over the course of the next month prior to the deadline of 5 p.m. on June 27, 2016. To clarify, the initial document I downloaded from HHS/CMS and read was 962 pages, but my comments will refer to the document as published in The Federal Register on 05/09/2016 corresponding to numbers indicated in the right lower corner of each of 625 pages. The Table of Contents alone spans 12 pages. The rule does not reflect the stated intent of MACRA and represents brazen overreach by an Executive Branch agency including expansion of powers, changing the intent of the law, and violation of Constitutional rights of the people.

Your Executive Summary’s Purpose states on page 18 that you “rebranded key terminology.” Such Orwellian attempts at crafting current day Newspeak do not distract the people of the United States from recognizing inherent hazards of your goals of collecting the most intimate, private, personal details of our medical histories without our knowledge, consent, or authorization and forcing physicians under threat of penalty to disclose our patients’ protected health information to you in violation of our code of professional ethics using untested, unproven, unsecured, interoperable, bidirectional electronic health IT for surveillance, data collection, and use by the Secretary of Health and Human Services and her agents for whatever purposes she deems appropriate including selling the data to intermediary bodies of her own approval. The change of the name of this deplorable practice from “Meaningful-Use Electronic Health Records” to “Advancing Care Information” does not change the reality that this constitutes a violation of “the right of the people to be secure in their persons…papers, and effects against unreasonable searches and seizures…,” otherwise known as Amendment IV of The Constitution of the United States, and puts us at risk of targeting by agents of the Federal government in the fashion of the Internal Revenue Service under the direction of Lois Lerner, former director of the Tax Exempt Division at the IRS a few short years ago. Such illegal search and seizure of our private medical e-papers and effects and targeting of patients and physicians based on their medical data and disclosure thereof has the potential to result in loss of life and liberty in time as the government arrogation of medicine becomes the politicization and ultimately the weaponization of medicine.

The rule’s intentionally confusing terminology, methodology, and criteria for the “All-Payer Combination Option, based on the Medicare Option, as well as eligible clinician’s participation in Other Payer Advanced APMs” (Alternative Payment Models)- which includes commercial insurance- is not convoluted enough to hide the truth from the astute and vigilant American people that this rule sets forth the codification of single-payer, government run socialized medicine in the United States of America. No, we will not be fooled again by such games in the fashion of MIT economist Jonathan Gruber and his intentional misleading and mocking what he calls “the stupidity of the American voter” as he strategically crafted the ACA to “exploit the lack of economic knowledge” of the American people.

That the rule (page 23) aims to redistribute $833 million between 687,000 and 746,000 eligible clinicians in the MIPS system and between $146 million to $429 million to between 30,658 and 90,000 eligible clinicians in APMs in 2019 alone in order to “drive” government –directed changes (termed quality improvement) in provision of “care to Medicare beneficiaries and to all patients in the health care system” amounts to extortion of physicians and conscription of patients via expansion of MACRA rules from Medicare beneficiaries only to include “all patients” by the government in an unauthorized massive grab of power, money, and the lives of the American people.

MACRA was passed as a bipartisan bill and was sold as a repeal of the dreaded unworkable SGR, which it sunsets in Section 101, but this rule does vastly much more to expand the power of CMS and other Executive Branch Agencies and their control over all physicians (not just Medicare enrolled) and all patients (not just Medicare beneficiaries). The use of IT to achieve this end as proposed in this rule is chilling. My comments pertaining to this will follow in my next Daily Dissent.