Physician blasts MACRA, calls regulation a 'trojan horse for government takeover'

Kristen S. Held--Opthalmologist who opposes MACRA

While the Medicare Access and CHIP reauthorization act may have met with bipartisan support from Congress, it is meeting with significant opposition from some doctors, clinicians and other stakeholders.

One such doctor is speaking out against what she perceives as potential gross invasions to patient privacy and negative impact to many small practices and solo providers.

The new rule, set to be finalized in November, replaces the Sustainable Growth Rate with a new system whereby providers are judged by a set a quality measures set forth in MACRA's Quality Payment Program. Reimbursement rates, bonuses, and penalties will be based on data reported by providers under the program.

[Also: Doctors voice rising concerns for small practices under MACRA]

In fall issue of Journal of American Physicians and Surgeons, Held slammed the scoring guide, saying "scoring and grading physicians through financial incentives and penalties in order to drive behavior would, in other contexts, be called bribery and extortion."

She further defended the interests of small practices, pointing out that CMS projected a large number of solo practitioners and small practices will receive a "negative payment adjustment" and because the payment adjustments are budget neutral, shifting income from those who score poorly to those who do well, by 2022, the gap is projected to reach 19 percent.

MACRA replaces threatened SGR pay cuts, which were always postponed, with certain pay cuts for those who put patients ahead of system satisfaction, Held said.

She also attacks the pending legislation for creating the need for costly technological improvements and, in her view, essentially putting an end to privacy.

[Also: CMS chief Andy Slavitt again floats possible MACRA delay]

Participation requires costly Certified Electronic Health Record Technology (CEHRT), and she highlighted the fact that physicians are required to certify to CMS that they will cooperate with the Office of the National Coordinator for Health Information Technology surveillance that they will not block government access to their practice's EMR's, including patients' individually identifiable health information, stressing that CMS could require access to 10 or more years worth of a patients' information without their consent.

"Ultimately, private physicians cannot ethically comply with MACRA," Held said. "If this rule goes forward as promulgated, many more physicians will opt out of Medicare and commercial insurance to pursue successful practice models, providing an alternative for patients also."

[Also: Enter MACRA: CMS chief Andy Slavitt says new law lets doctors be doctors]

Roughly 4,000 formal comments about the proposed rule have been filed and CMS continues to seek feedback.

In recent months, CMS Acting Administrator Andy Slavitt has twice hinted that a delay in the implementation of the law could be possible, largely for the sake of small practices who need more time to prepare.

Twitter: @BethJSanborn