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New Fed Rules on Medicare Payments Will Drive Still More Physicians To Quit Treating Elders, Exit Doctoring Altogether

Oct. 21, 2016 (EIRNS)—New rules were announced on Oct. 15 by the Federal Centers for Medicare and Medicaid Services (CMS) which change drastically how Medicare will pay doctors for their services. This adds to the already severe trend of doctors opting out of treating Medicare, Medicaid, or CHIP (poor children) patients, because of being stiffed for payment, coerced on how to treat, and slammed with e-records mandates. Already, even patients able to have Medicare supplemental insurance or Medicaid, often desperately search for a doctor "who will take them."

The new payment system is called MACRA—Medicare Access and CHIP Reauthorization Act of 2015. It greatly increases the documentation burden, among other things. The rules and terrible impact are described today by Dr. John S. O’Shea, in an article, "Risk of ‘Mass Exodus’ of Doctors from Medicare," posted on

O’Shea writes that, under MACRA, there are two payment options: Merit-Based Incentive Payment System (MIPS), which determines payments based on competitive merit test scores; and Alternative Payment Models (APMs) which give "incentives" to doctors to work together towards eliminating unnecessary spending. But meeting the documentation requirements for MIPS costs a doctor an average of $40,069/year in time away from patients—785.2 hours/year. A recent survey of doctors found that two-thirds did not feel the added documentation improved the medical treatment for patients in any way.

It should be noted that American doctors have for decades already increasingly struggled under growing burdens of documentation and insurance paperwork.

The other option, APMs, is also a nightmare. The Obama administration has set a goal of half all Medicare payments being processed through APMs by 2018. This means more and more reliance on Accountable Care Organizations (ACOs)—treatment teams, intended to drive down care and costs. But, so far, ACOs have not reduced costs at the rate expected rate by the CMS.

In short, a recent survey indicates that 40 percent of physicians expect a "mass exodus" from Medicare due to MACRA demands.

"If MACRA is implemented according to the arbitrary timeline set by the administration, it could force doctors to abandon private practice for salaried positions or leave practice altogether—neither of which would be good for patient care.”

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