My recent post appeared to catch the attention of Mr. Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS):
My article recapped another day of insanity within our healthcare enterprise, and yes, taking a look, Mr. Slavitt, would be greatly appreciated.
Choosing to see, however, is my challenge for you—for as a friend reminded me, you seem to be very good at “feeling our pain.”
But, I must admit, thanks to you, I was contacted by a CMS official overseeing the startup of MACRA.
For those that don’t follow healthcare policy closely, MACRA is our government’s latest medical project. Another soon-to-be-implemented healthcare law with 962 pages of rules, including the most recent method devised to pay physicians, something known as the Merit-Based Incentive Payment System (MIPS).
CMS was seeking my perspective on MACRA and MIPS.
My written response to them—edited only somewhat for brevity—is shared below:
I’m obsessed about finding ways to better deliver high-quality and affordable medical care.
And, yes, it obviously starts by eliminating the medical waste that’s preventing it. What’s on the chopping block for today?
Mandated medical documentation.
Follow me around for a single morning. It’s the most obvious waste you will recognize.
Ninety-five percent of it might as well be monkeys typing on a typewriter. No one providing care wants to read any of it. Because it’s not helpful.
There are lots of letters on the page. And, there are lots of pages.
Frequently, it’s an unsolvable puzzle. In fact, I challenge you to find much of anything that really matters inside a patient’s chart anymore.
I guarantee you the insurance companies don’t read any of it. I send them records all the time trying to get studies approved for my patients. They read absolutely none of it.
They just deny the test. Then, I have to call them. Wait on hold. Talk to a nursing supervisor. I just hung up the phone with one a few minutes ago. Do you know what she asked me?
“Doctor, can you tell me the reason you are ordering this test?”
I sent you two-dozen pages of notes. You are looking at them now. Why don’t you read what I send you?
I’ve got my theory on this one.
WE HAVE ALL JUST GIVEN UP.
My satellite clinic is about an hour away. I drive there with my nursing staff each month.
We load up ECG equipment, pacemaker programming machines, and a few other doctoring items in my truck.
I provide services to an area that has no permanent resident doing what I do.
Then, I return home.
Today is one of those days. I arrive back to my main office. It’s after 5pm and officially closed for the evening. I hurry to help my remaining staff return numerous phone calls to patients who had left messages while I was away. I hope to finish up at the office soon. Then, I intend to check on a patient at the hospital before making it home for dinner with my family.
I peer down at a piece of paper on my desk, given to me by one of my staff. It’s a printed email message. Sent by the Centers for Medicare and Medicaid Services (CMS).
The message is arguably from the most descriptive email address on the planet—and I’m not making this up—it’s from DONOTREPLY@CMS.GOV.
It’s rather fitting.
Because they definitely don’t want you to reply. That would be easy for me. Too efficient, perhaps. No, they don’t want a reply. They just want me to DO what they say.
I arrived with my family. I handed the usher our tickets.
We entered the auditorium. The stage was lit. We were directed to our seats.
We were there to watch an OPAS Junior production—a performing arts play for families and children.
The performance would soon be what we paid for, an enjoyable Sunday afternoon event with my wife and boys.
The actors and actresses did their job. They appealed to us, the audience. They danced, sung songs, provided humor, and so forth. They were there for us that day. And, we were there for them.
We paid for their performance. And, they gave us one.
* * *
A compelling strategy has consumed American healthcare. It’s known as pay-for-performance. It’s trying to replace our unknown fee-for-service model, because it seems more logical.
I enjoy documentaries. My wife says she enjoys watching them with me. The way I usually see it, they help her fall asleep.
But, not this one.
Not Poverty, Inc.
If you haven’t watched it, you should. We both enjoyed it.
It’s not one of these pick-a-political-side kind of shows. For the record, people across the political spectrum have endorsed it. The film has won like forty honors and twelve awards that I know absolutely nothing about. But, if you watch it, you’ll get the gist why.
We occasionally need disruptive thinking. Something to challenge our perception of reality. We actually need more of this when contemplating healthcare delivery, too. But, I’m not talking about that right now.
Poverty, Inc. is about poverty… and the humanitarian aid we use to fight it.
It’s also about government. And, business. And, how the collusion of these things isn’t solving poverty at all. Like I said, you should watch it. It provides you a fascinating perspective.
I won’t give it all away, but there are a few predominant themes that unfold in the film as you watch it.
Cancer screening has NEVER been shown to save lives.
That’s the eye-catching title of a recent article emanating from Academic medicine.
I liked it.
I’ve known for some time that we bother too many patients with absolutely no symptoms of disease under the guise of Evidence Based Medicine (EBM). So, of course, I started reading it.
The lead author has been involved with other discombobulating publications of statistical mumbo-jumbo. So, naturally, I wondered what sensible and non-sensible use of statistics I’d encounter.
It didn’t take long for me to find both.