Daily Dissent, Day 3: Comments to CMS on MACRA proposed rule

Tuesday, May 24, 2016

Dear CMS Acting Administrator Andy Slavitt,

The MACRA proposed rule requires extensive comment; therefore, I submit my daily dissent part three, focused on Pages 35-37. Section C (2)(b), Support for Health Information Exchange and the Prevention of Information Blocking, amends MACRA and requires that to be a meaningful use EHR user, an EP (Eligible Professional) must demonstrate to your agency that that he or she has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of your certified EHR technology. Your rules make corresponding amendments to MACRA applying this to hospitals and critical access hospitals as well. Your rules require us to make a three-part attestation:

  1. That we did not limit compatibility or interoperability of your certified EHR (AKA that we did not block you from getting into our system to steal our data or put yours in.)
  2. That we did implement technologies, standards, policies, practices, and agreements calculated to ensure that the certified EHR was at all relevant times connected (AKA whenever you want it) in accordance with applicable law, compliant with all standards applicable to the exchange of information, … and implemented in a manner that allowed for timely, secure, and trusted bi-directional exchange of electronic health information with patients, other health care providers, including unaffiliated providers, and with disparate certified EHR technology and vendors.
  3. That we respond in a timely manner to requests to retrieve or exchange electronic health information, including from patients, …and other persons, regardless of the requestor’s affiliation or technology vendor.

In other words, a doctor like me must sign documents promising to and then prove that I will grant interoperable, bidirectional exchange of my patients’ private data with any person, regardless of affiliation or technology vendor, to whom your agency says I must give the data. I must transmit this data quickly and must leave my system connected “at all relevant times”, in other words, whenever your agency wants access to the data.

First and foremost, I am a physician engaged in on-going, valid patient-physician relationships founded on the Hippocratic Oath of medical ethics and grounded in mutual trust. My duty is to my patients, not you and your overreaching executive branch agency. I have sworn an oath to keep my patients’ most private, intimate, sacred medical history confidential. My pledge is to keep my patients’ information from you not transmit it to you.

Through your rules, you are asking me to disavow my professional code of ethics and Hippocratic oath, betray my patients, and instead attest to you that I will give you and anyone of your choosing unfettered access to my patients private, protected health information health whenever you want it. Is this a joke? Why would I do this? For a bonus from you? To avoid a penalty from you? To avoid public humiliation when you give me a 0 for not complying with your rule and then you post my failing Composite Performance Score on your public CMS website?

Sorry to inform you, but not bribery, not threat of financial ruin, and not oppressive public humiliation will cause me to violate my professional ethics and lifelong commitment to my patients. You have grossly underestimated the integrity, heart, and soul of America’s physicians. What we and our patients share is beyond anything you and your agents of government have ever experienced nor can fathom. You should try it sometime. What is more troubling than the data you plan to extract and sell is the cookbook guidelines you plan to insert and require me to follow in the care of my patients. This rule is deplorable, outside the intent of the law, and a violation of humanity. Strike it out. More dissent to come tomorrow.


14 thoughts on “Daily Dissent, Day 3: Comments to CMS on MACRA proposed rule

  1. Pingback: Daily Dissent, Day 3: Comments to CMS on MACRA proposed rule | drginareghetti

  2. If I can’t trust my doctor, then who can I trust? Thank you for standing up against the unethical, immoral reach of this tyrannical government! I believe doctors have the highest ethical standards of any profession and as such, earn and deserve our respect and support.

    • And as physicians we must fight for our patients and sanctity of the patient-physician relationship. The ability to relate with one another with dignity and confidentiality. Thank you for understanding the critical nature of this fight. By opting out of Medicare instead of enabling this perverse system I am standing for my patients not abandoning them.

  3. I’ve maintained health insurance well before barry and his cohorts over took our health care industry. I refuse to join any group that supported ACA and will remain with United ONLY because they are withdrawing from the program, though the damage is done between me and my insurer. I commend your position. Too few people are willing to stand against the federal government with their resources and threats, like those you mention. Your refusal not to abandon your values, principles, patients and oath is inspiring. Keep the light burning. It’s a beacon for those searching for answers to a complex issue.

  4. As a physician of some 46 years and as a health and freedom advocate I applaud your loud and clear defiant stance.
    In 1998 I was one of the first physicians in the nation to withdraw from Medicare when a mechanism was provided to do so under Kennedy-Kessenbaum. I did so in order to treat patients as they and I decided was in their best interests, and do so at no fee or a reduced fee if I so chose without being guilty of the felony crime of “inducement”.
    Today we are seeing supposed health care used to limit, control and, yes, even kill, not only confidentiality, but actual patients.
    No care without vaccines. No care without whatever the system decides I should have. No care without informed consent waived to accept anything the doctor wants me to have – or not have.
    WRONG! Informed Consent prevails since it is guaranteed by International Treaty, which supersedes national, State and local law or regulation.
    Please visit http://www.DrRimaTruthReports.com/AdvanceVaccineDirective to learn more about how to protect yourself and preserve your health care rights.
    Physicians, be aware that violating that Informed Consent right can be interpreted as assault, battery and potentially as a Crime Against Humanity.
    And, Dr. Krisheld, I would like to invite you to be a guest on my live webcast, the Dr. Rima Truth Reports.
    Please contact me to set up a date.
    Yours in health and freedom,
    Dr. Rima
    Rima E. Laibow, MD
    Medical Director
    Natural Solutions Foundation

    • Thanks Meg! How can I cross post this on RebelMD? My brain lost the passwords necessary to do so. Ug. And thank you for your continued outstanding work!

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