Daily Dissent 9 to CMS’ MACRA proposed Rule

Friday, June 03, 2016

Daily Dissent 9

Dear Mr. Slavitt, Acting Administrator CMS,

I am pleased to see my comments finally posted on the CMS site. Although I have been submitting them daily for the last 13 days, they were held until yesterday and posted at once. A CMS employee was kind enough to call me at my office yesterday to inform me that my comments could not be posted, because they contained “proprietary information.” I was perplexed by her assertion having painstakingly read the law and rule and citing supporting information verbatim from the proposed rule. Turns out the banned “proprietary information” was simply the name of a government agency official who had targeted individuals based on political preference and the name of a government-contracted ACA economist who had taken advantage of what he called “the lack of economic understanding of the American people” in his economic design. Further, she wanted me to submit all comments in a single attachment and informed me I could get a confirmation email. I told her I believed she was suppressing my speech and that she could redact the “proprietary information” then publish my dissents individually as intended. I informed her I did not want my comments to show up obscurely as a single paper clip icon, but as 8 individual ready-to-read dissents. I further told her, not only do I know about the email confirmation option, but I have screen shot and photographed my 8 confirmation numbers- just to be safe. You see, I have spent countless hours reading the MACRA laws and rules, and I want truth to be told to my fellow Americans, who in recent history have been deceived by what you and your coworkers in the multitude of Executive Branch departments and agencies say is in the laws vs. what truly is in the laws. I would love to name names of government officials who told us things like, “we’ll have to pass the law to see what’s in it” and “if we like our doctors, we can keep our doctors” to factually back up my point, but then this dissent might be withheld from posting on the basis it contains “proprietary information” as well.

The proposed MACRA rule is an assault on the American people. Unless struck down and MACRA repealed, your agency, CMS, will have expanded its powers in unprecedented and unconstitutional fashion. The rule grants CMS access to any and all protected health information of ALL patients in the US without their authorization via a new class of intermediaries that must keep the data for CMS audit for 10 years minimum, if not a lifetime in targeted cases. My 8 prior dissents address this in detail.

The proposed rule defines its All-Payer-Option, which is single-payer, government-run medicine.

The proposed rule incentivizes physicians and hospitals to merge into huge groups, like failed HMO’s of the ‘90s, that must comply with your data reporting, including maintaining interoperable, bidirectional, unblocked certified electronic health records that must be available for surveillance during all relevant times, including on-site inspection.

Physicians will be graded and receive a Composite performance Score from 0-100 for following your top- down rubric in grade school fashion- except that the scores will be publicly posted to intimidate, oppress, and humiliate those of us who will not comply and to glorify those who best do your bidding. Those with the high scores will receive more money from you. Those with the low scores will be penalized monetarily and forced out of business in short order. An example of a Clinical Practice Improvement Activity Measure for which a physician will be rewarded with 20 points by CMS is creating or contributing patient mental health/ behavioral health data to a national, state, or local registry. The potential for malfeasance with government control over such data is chilling. The MACRA plan to bribe, extort, coerce, and punish physicians in order to drive their behavior is more suitable for the Mafia than the US government.

What MACRA and its proposed rule do is require physicians to violate their professional code of ethics, betray their patients, and turn everything over to your agency. And on whose authority do you do this? My allegiance is to my patients, and my job is to keep their private medical information from you not transmit it to you. I will treat them according to my time-honored professional standards not CMS’ global population-based government experimentation.

Finally, I have looked at the projected costs of this fiasco as outlined in your rule. Hundreds of billions of dollars that could be better spent on patients or kept by taxpayers will be squandered on a whole new bureaucratic wasteland of intermediaries leeching off IT and data marketing. Groups like the ONC-ACBs, QCDRs, and Health IT Vendors will siphon hundreds of billions from patient care. And if these bodies and registries are disqualified, the physicians and their groups are left holding the financial burden and assuming the financial risk. Your pet insurance and IT companies stand to make billions at minimal risk. I read one projection that an individual physician could be out $33,000 and a large group up to $6,500,000 per year if the ONC-ACB, QDCR, or other new bureaucratic intermediary they work with is suspended or disqualified. The lobbying efforts (money and power) and incestuous conflict of interest (money and power) at play here is beyond epic.

We really must talk. I will email you this weekend. You have my email and phone number as well. Time is of the essence as is the lifeblood of the USA and her patients. The MACRA rule must go and MACRA must be repealed.

Sincerely,

Kris Held, M.D.

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