Sunday, May 15, 2016

My Letter To Andy Slavitt Regarding Regulations For the "SGR" Replacement MACRA

Mr. Andy Slavitt Acting Administrator Center for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Re: MACRA Regulations Dear Mr. Slavitt, While trying to control costs, Congress and CMS have over the years been in the process of destroying the patient-physician relationship, paradoxically increasing costs. MACRA only exacerbates this problem. This has happened as physicians take time from patients to enter data demanded by the bureaucracy. Additionally physicians have less time to think about and conceptualize their cases causing the need for greater testing. It is true that healing is better when patients feel a bond with their physician. This is becoming more difficult as the government tries to micro-manage the patient-physician interaction. Also the negative impact of this law on physician training will be massive. Residents now are spending more time with computers and less with their patients. Their history taking and physical diagnostic skills are rapidly decaying. Thus, in the future, we will have physicians with less skill needing to order more tests greatly increasing costs, while providing care of lower quality. The idea of providing bonuses and penalties around an arbitrary price-fixed amount devoid of market verification is economically unsound. The value of a physician visit should be determined by the individual patient and not by a distant bureaucracy. A way to accomplish this change would be a voluntary program for seniors. Those who wish to do so would have an actuarially determined yearly deposit into a special health account. This account would be used to pay for most outpatient care and fund a nationally available high deductible plan. In this light the only solution regarding regulations for MACRA is for your agency to return to the Congress and ask for re-addressing the “SGR FIX”, advising them to implement this voluntary Medicare plan addressing physician re-imbursement. Sincerely, Kenneth A. Fisher, M.D. Nephrologist – Author “Understanding Healthcare: A Historical Perspective” Cc. Congressman Fred Upton

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