Daily Dissent, Day 6, to CMS’s proposed MACRA Rule

Saturday, May 28, 2016

Dear Mr.Slavitt, Acting Administrator CMS,

By now you should have received five prior dissents to the proposed MACRA rule from me, although I do not see them yet posted on your site. I will make this one shorter and focused solely on page 431/625 regarding the proposed 414.1460 Monitoring and Program Integrity section, which is beyond your capability. You might as well propose to establish a rural health clinic on Mars.

Specifically absurd is (c) Information submitted for All-Payer Combination Option. You state that information submitted to you by physicians and all reporting eligible clinicians and Advanced Alternative Payment Entities may be “subject to audit by CMS.” And further you state that we must maintain copies of any supporting data (which includes our patients’ private records including their protected health information) for at “at least 10 years.” Further you will recoup payment based on your audit.

Is this a threat to the nation’s physicians and providers of health services to the people? This would be laughable if it weren’t so potentially harmful to the very lives and liberty of the American people. You and your agency have NO RIGHT to our protected health information at your whim. When you say at least 10 years, would your corroborating agencies determine this to be lifetime access?

There is no limit to the potential for abuse and malfeasance by the Center for Medicare and Medicaid Services under the auspices of the Department of Health and Human Services under the administration of the President of the United States of individuals’ personally identifiable health information, which includes all demographics, past, present and future, physical and mental history, medications, treatment, and so forth. Similar Executive Branch agencies like the IRS under Lois Lerner and John Koskinen and the NSA with its assumed metadata powers, have taken on a life of their own expanding their scope and strength of powers to intolerable levels (and by whose authority?)

History has proven agencies such as yours cannot and should not be trusted with such vast amounts of medical data, that constitute the very lifeblood of the United States citizenry. This rule must be struck. CMS must be denied the power to audit the medical records of each individual American for what will be at least 10 years, and could be their entire lives.

While CMS was created to manage Medicare and Medicaid, MACRA and your proposed rule, through this preposterous “All -Payer Combination Option” (Newspeak for single-payer government-run socialized medicine), grants you access to ALL patients. I can imagine no American who would support a group of DC bureaucrats having lifetime access to all their records- particularly as you have proven time and again you cannot protect the security of this data.

The cost of undertaking such a ludicrous proposal is not conscionable, and pragmatically speaking, on a macro level, your programs are broke and are bankrupting the US economy. How do you expect doctors and all eligible clinicians to do this at the micro level?

This rule is an abomination the Constitution of the United States and an affront to her people. Strike it.

Sincerely,

Kris Held, M.D.

Addendum for those who think I’m exaggerating see Page 432/625: And I quote-

(e) Maintenance of Records. An Advanced APM Entity or eligible clinician that submits information to CMS under 414.1445 for assessment under the All-Payer Combination Option must maintain such books, contracts, records, documents, and other evidence for a period of 10 years from the final date of the QP Performance Period or from the date of completion of any audit, evaluation, or inspection, whichever is later, unless-

(1)CMS determines there is a special need to retain a special record or group of records for a longer period and notifies the Advanced Payment Entity of eligible clinician at least 30 days before the formal disposition date; or

(2) There has been a termination, dispute, or allegation of fraud or similar fault against the Advanced APM or eligible clinician, in which case the Advanced APM Entity or eligible clinician must retain records for an additional 6 years from the date of any resulting final resolution of the termination, dispute, or allegation of fraud, or similar fault.

Translation: CMS can retain targeted records for eternity with a 30 day notice per (1), 2o years minimum and going forward in 10 year chunks for eternity per (e), and 16 years per (2).

And remember, the Office of Civil rights said eligible clinicians can disclose protected health information to these agencies via ONC-ACBs (Office of the National Coordinator for Health Information Technology Authorized Certification Bodies). You tricky devils, you. So, much for our “civil right to privacy” and our “civil right” to the Fourth Amendment.