The Carrot and The Corn

Just got home from DC where I met with the Acting Administrator of CMS, Center for Medicare and Medicaid Services, and his team, to discuss the MACRA proposed MIPS/APMs rule, because I am fighting for the survival of the American patient. We are all patients. I read the convoluted laws and rules our government is imposing on us. I dissent. I propose solutions. I bought my own ticket, paid for my own hotel and cab rides, and bought my own food. I incurred debt in order to go; my overhead as a solo practitioner is huge, and the day out of the office went straight to the expense column. The income column remained empty.

I live my life grounded in principle and truth. I will fight for what is right. I cannot be bought.

I opened my laptop to report on my meeting and saw the JAMA piece disparaging and degrading physicians, implicating we prescribe drugs for patients because pharmaceutical reps bring us lunch.

My colleague, Dr. Meg Edison, posted an eloquent rebuttal on Facebook. I look forward to thousands of hard-hitting responses from physician colleagues across the country. Mine is not eloquent.

Physicians are a special lot. We are selected for admission into medical school based on flawless character, stellar and rigorous academic achievement, and a multitude of other factors that demonstrate we possess the requisite traits to survive the rite of passage one must endure to become a physician. I have the utmost respect for my colleagues. Throughout our lives, we have proven strong and courageous, trustworthy and honorable. From college and medical school, internship and residency, to fellowship and practice, we sacrifice our personal lives and work undeterred in service of others. Most importantly, we cling to our professional code of ethics and the patient-physician relationship.

In stark contrast, stand the political elite (with rare exception) who operate according to an antithetical code of ethics. Ironically, they are the ones who create and execute the very laws and rules, which they inflict on us, and destroy everything the physician holds dear- our ability to autonomously care for the patient, confidentiality, and freedom to innovate. We are constrained, if not indentured. Oppressed, if not abused. And we take it, our actions implying, “Thank you, sir, may I have another?” The insider elites, on the other hand, project their inherent tendencies to be bought and sold in pursuit of self-gratification onto us. They pass laws such as The Sunshine Act that was enacted along with the Affordable Care Act in 2010.

The DC insiders believe physicians can be bought and sold like they are. The Sunshine Act requires pharmaceutical companies to report to government everything they do with respect to physicians, and this information is posted on a public website. I had fun looking myself up to see what I had eaten for lunch, apparently in criminal fashion, over the past couple years.

Used to be, relationships between physicians and drug developers were collegial, intellectually stimulating and useful, provocative and inspiring. We would interchange ideas. What do patients need? Can they make a drug that cures disease X? Or make injury Y heal faster? Or relieve pain and suffering from condition Z? Or can they make it sting less, taste better, and go down or up easier? What are potential uses of their drugs, and what will make the drugs better? Now, it is a federal crime to even discuss “off-label” uses of drugs. We cannot engage in academic discussion. We cannot interchange ideas. Government says “No!” What a waste. I hate it. I’m bored to tears. Innovation is stifled. I prescribe generics of the same drugs I prescribed 20 years ago, except that they’re vastly more expensive now, and it requires jumping through hoops to get insurance companies and pharmacies to fill my prescriptions, which are now called requests.

Pharmaceutical representatives come to my office rarely now, but usually I’m busy seeing patients. They sometimes bring lunch, so we can talk while we eat between morning and afternoon clinic. Do members of other professions eat? Do other professionals go to lunch together? What about those elite DC lawmakers? Do they eat lunch with anyone ever? Do they “talk”?

Per the Sunshine Act, anything a physician eats must be reported to government to the penny. The elites and their band of merry cronies and enablers now use this information to portray physicians as hungry, cheap-date, sell-outs, who prescribe whatever the drug rep peddles for chips and tea. This is insane.

Recently, I invested in an innovative laser to improve cataract surgery for my patients. The company that developed the laser hosted a physician speaker, who had performed thousands of procedures on the laser, to speak in my hometown. I was exhausted after a long day at work and wanted to see my family but knew it would benefit my patients if I listened to this more experienced surgeon as he related the pearls and pitfalls of this new technology. The talk was at a distant hotel, and dinner was served. I couldn’t resist, I had a few brussel sprouts, a few bites of chicken, and several tastes of a dessert sampler, as the presentation progressed. Then the sign-in sheet was passed, and I was asked for all my demographics, including my medical license number, Medicare NPI, and if I had consumed a meal.

I suddenly felt ill. Dirty. Violated.

Had they filmed me eat? Had I eaten too much? Had I had too much cobbler and not enough sprouts?

I refused to sign. I admit it. It was all just too insane and surreal. Insulting and juvenile.

If they really needed us lowly physicians to attest to whether or not we had “consumed a meal”, in the world of mistrust and malfeasance they had projected on us, and in the vein of the quality measures and MACRA MIPS they had passed to control us, they needed proof positive. A better measure would be not if we consumed the meal, but if and when we actually passed the meal.

In the future, maybe government will amend the Sunshine Act to require all pharmaceutical and device companies to serve at least one food item, which the physician is required to consume, that contains a readily identifiable food product like corn, so the physician can prove positively at the site of production that the food was actually consumed. The transit time would confirm that the food was indeed ingested at the respective company’s event. The physician could then photograph the product using a cell phone and securely transmit the data to an interoperable, bidirectional, unblocked government portal. The physician could then be scored on efficiency and quantity of product transferred. Rapid response would be correlated with rapid transit time, which would be considered a high outcome measure, while high quantity would be regarded as over-utilization of resources and would be scored poorly. An overall composite performance score would be given and publicly posted. Based on the score, the physician would then be rewarded with a positive payment adjustment factor or penalized and have to pay the device company back for the price of the dinner and the speaker’s airfare and meal. Using the government’s “rebranding of key terminology” strategy, this new model is now called the “the carrot and the corn” model, as opposed to the older, unfriendly-sounding “the carrot and the stick” of days gone by.

I feel better now.

If you think I’ve lost it, just read the MACRA law and its proposed rules, you’ll see I’m just applying their law. If you think their law is crazy, go to the CMS website and post your comments by June 27. Fell free to tell them to stick it where the sun don’t shine.






4 thoughts on “The Carrot and The Corn

  1. You are my hero! I am a former ER physician, turned stay-at-home mom, due to all the insanity of our profession. You put words to my feelings. Thank you.
    Julie Brown

  2. Pingback: The Carrot and The Corn

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s