Another Physician Dissent to CMS MACRA Rule

Good afternoon, Ladies and Gentleman,

My name is Dr. Richard Armstrong. I am a general surgeon who has been in practice for 35 years since completing post-graduate training. I have been in the military, in academics, in private practice and now employed. I have watched the development of the federal medical bureaucracy since 1976 and opposed more government intervention then in public in a letter to the Washington post. I did this as an active duty naval officer and received hundreds of letters of support.

In 2009 after President Obama spoke before a joint session of Congress about health care reform, I wrote to him with a simple specific request. I asked him to please speak with the doctors on the front lines, the dedicated physicians and surgeons who care for all of you and your families day and night…24/7. The fellow human beings who are there for you when you need us and who passionately care about our profession and our patients. Of course, my plea went unheeded, so I joined a group of concerned physicians and traveled to Washington to read my letter in public on October 1st, 2009. This was the beginning of a national movement to return the leadership of our proud profession to those who understand what it is to care for individual human beings, one at a time, face to face, with dedication, compassion and excellence. That movement is growing.

I opposed the ACA, not because we didn’t have problems to be solved in American health care, rather because building a much larger and more complex federal bureaucracy is not the way to do it. Bureaucracies grow themselves and in the process they steal valuable resources and more from those who support them…American citizens. The administrative arm of the Executive Branch of our government is given “instructions” from Congress to carry forward. This is how a “small” law like MACRA can turn rapidly into the proposed final rule we are discussing currently, and frankly, it is a mistake.

We understand that the Medicare and Medicaid programs must work to purchase value for those who are accessing the program and we also understand that the underlying flaw in these programs has been present since they passed in 1965. You see, demand for these services will always outstrip the ability of our medical professionals to supply them…always. Congressman Wilbur Mills knew this leading up to the passage of Medicare which is why he opposed it…as a Democrat.

My friends, MACRA, the APMs and the MIPS do not “simplify” things for American patients and their physicians, they make them more complex and more expensive, but the money is spent unseen by the patients and out of their control. We need to end this spiral of building larger and larger complex bureaucracies which is essentially an “inside the beltway” disease. In our banking sector it has destroyed local and community banking. Now in the medical sector we are destroying local and community hospitals and the private practice of medicine, while supporting and encouraging consolidation and corporatization of medicine.

I would assert to you that it is not the federal government who should be defining what quality medical care “looks like”, rather it should be the patients, the consumers of health care services who know quality when they see it who should be the final judge.
We need to move toward more consumer oriented health care for ALL Americans and not fall into the trap of believing that we are somehow “smarter” than the millions of people who access this care daily.

We need to recognize that the complex act of reporting metrics to the federal government and others has not been shown to improve quality as was documented well in the recent “Health Affairs” article from the Weil/Cornell Medical Center which points to the tremendous cost and loss of productivity this process causes for American physicians.

Yes, the SGR was flawed and needed to be reformed. However, what we needed was true simplification and if CMS wanted to collect data, then put a very simple process in place which physician practices can understand and is based on positive incentives which are meaningful and add to the quality care which we work to deliver.

Physicians account for between eight and ten percent of the budget of CMS and yet it appears that we are being singled out for what feels like punishment. My colleague and friend, Dr. Mike Koriwchak is having a constructive and ongoing dialogue with Mr. Slavitt about these important issues. We represent the Docs 4 Patient Care Foundation which has been working tirelessly on behalf of patients and doctors since 2009.

We appreciate the dialogue and respectfully request that this final rule be modified and if possible significantly delayed until American working doctors have a chance to learn what this means for their patients and their future.

Richard A. Armstrong MD FACS
The Docs 4 Patient Care Foundation


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