For those who are no fans of the Affordable Care Act (ACA) Dr. Kris Held, a Texas ophthalmologist and health care policy analyst, recently said that Obamacare is nothing compared to the Medicare Access and CHIP Reauthorization Act (MACRA) law.
MACRA creates a new payment system for reimbursing doctors who care for Medicare patients that is based on Merit-Based Incentive Payment System (MIPS) scoring. On Jan. 1, 2017, the government will start scoring doctors to determine how much they are paid.
The densely written 962-page law comes with a 500-page instruction manual on how to properly read it.
“(MACRA) is a Trojan horse,” Held said during a recent interview with Dr. Dave Janda on his Operation Freedom podcast. “The government anoints themselves greater powers."
Doctors will be graded based on how well they follow ACA and MACRA rules.
“If you keep a registry on your patients, like a behavioral health registry, you get a lot of points,” she said. “Do you think there is any potential targeting with that? I think that I just laid out a case that we’ve got some problems.”
Held said the government even skirts HIPPA privacy rules with MACRA.
“We now have to disclose protected patient information without patient authorization,” she said. “They can even come in and do on-site surveillance. So they have created a back door to get into other people’s medical records, down to medical issues, operations, medications and even psychological evaluations.”
Even more, those who refuse to comply will also be scored.
“When you go ... to see what kind of doctor I am, I will have a zero,” Held said. “It is like a big red letter 'A,' like the Scarlet Letter. I am going to have to wear a big red zero.”
Held’s private practice in San Antonio doesn't work with third parties, which means she does not deal with Medicare, Medicaid or health insurance companies.
Held said it has been difficult explaining her methods to patients.
“It breaks my heart when patients say, ‘You aren’t taking my insurance, or you have abandoned me,’" she said. "I have not abandoned patients. My agreement is with them. I take every patient. I don’t take the top-down, unethical mandates that are coming from government and insurance.”
Held explained that she is not stepping away; instead, she is stepping up in a different manner. She is trying to educate the public about what’s really happening.
“Insurance companies are looking at the bottom line; they are looking at money,” Held told Janda. “They are not concerned with the patient’s best interest. It is unethical for me to continue with an agreement to do what government and health insurance companies say.”
She explained that if physicians do not want to contribute to the government's system, it can destroy small practices.
“If you are in a practice of 100 people or less, (the government) want(s) to drive everyone to working for hospitals and big groups and government-controlled things,” Held said. “This MACRA law will affect every patient, not just those on Medicare.”
Held believes physicians and patients need to say no to this.
“(The government) has underestimated the moral fortitude of the American physician and the American patient; and when it boils down to it, 60 percent of people cannot lose their doctors in the U.S.,” Held said. “They just can’t, and (the government) will be responsible for that."
