Miffed MedPAC Mainly Mad at MIPS

The circle of life comes around again.

MedPAC, whose members include physicians, healthcare executives, and other policy experts charged with advising the Department of Health and Human Services on Medicare policy issues is mad at MIPS or the Merit-based Incentive Payment System.  Don’t forget that MIPS is the umbrella for MACRA or the Medicare Access and CHIP Reauthorization Act.  Rember MACRA replaced the SGR (Sustainable Growth Rate) formula. There is also the APMs which are the Alternative Payment Models. Got it?

As I have said here before, quality metrics have failed and will always fail. That never stops the government and policy experts, though.   Now they have some new acronyms:

  • Voluntary Value Program
  • Advancing Care Information (ACI)
  • Clinical Practice Improvement Activities (CPIA)

There is some more garbage at the end of the article and you can see it here but who really cares?  It won’t work. The whole point of this blog entry is to see if you could say Miffed MedPAC Mainly Mad at MIPS ten times without screwing it up.  Try it.  It’s fun.

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  16 comments for “Miffed MedPAC Mainly Mad at MIPS

  1. barb
    October 8, 2017 at 12:52 pm

    I don’t go to doctors, either. Don’t care to get on their payroll. The last fraud that I went to sent me, for weeks, to his PT department (he owned it) before he did another x-ray view that showed a dislocation. (I told him it was trauma, he said ‘froze up and arthritis’.) Then he sends me to a wrist surgeon two hours away, to see if surgery is an option, in view of ‘all the arthritis’. He needs a CT so it’s two hours home to get CT, two hours back to surgeon and two hours home again. Never did get surgery. All he could do was fuse two bones together to stop pain. The little bone pyramid in my wrist had collapsed due to the dislocation. You have to get to where you just walk out. I’m learning.

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    • Steve O'
      October 10, 2017 at 11:04 am

      You know, the Stark Act outlaws self-referral and has done so for over thirty years. Where did this event occur?
      I can’t understand some of your story. You had a bone fusion. Without surgery? How was that done?
      The condition you describe may have been a scaphoid fracture, which if untreated can progress into scaphonavicular advanced collapse. At that point, there is little to be done except hand therapy or surgical fusion. What was it called?
      I hope you can tell us more. I can’t tell from your narrative whether you got good care but an unsatisfying outcome, or substandard care.

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  2. JAMES
    October 8, 2017 at 12:48 pm

    CORRECTED SPELLING AND MISTAKES
    HERE ARE THE CHARGES
    TOTAL  $20,407.90

    ALCOHOLS -220

    BLOOD COUNT 126

    COLLECTION OF BLOOD 44

    METABOLIC PANEL 166

    COMPUTED TOMOGRAPHY – 4669

    CULTURE – 436

    DRUGS  34.95

    ELECTROCARDIOGRAM – 239

    ELECTROCARDIOGRAM 26

    EMERGENCY DEPT VISIT – 3000

    IV – 709

    IV – 486

    IV SOLUTIONS 55

    LACTIC ACID – 376

    LIPASE – 124

    HOSPITAL ROOM – 5824

    MED SUPPLIES – 19

    PROTHROMBIN – 78

    RADIOLOGICAL – 577

    PROPHYLACTIC – 209

    THROMBOPLASTIN – 87

    URINALYSIS DIP STICK 83

    BLOOD COUNT 126

    REACTIVE PROTEIN 142

    COMPREHENIVE METOBOLIC PANEL 166

    DRUGS 7.95

    LAB 365

    LACTATE 188

    MAGNESIUM 127

    PHOSPHORUS – 70

    SEDIMENTATION RATE – 98

    EMERGENCY ROOM DOCTOR SERVICES – 1001

    RADIOLOGY ASSOCIATES – 513

    =
    TOTAL = $20,407.90

    AND I HAVE MADE 2 FOLLOW UP VISITS TO THE FAMILY PRACTICE AT CENTRASTATE FOR WHICH I HAVE NOT BEEN BILLED YET AND HAVE NO IDEA WHAT THOSE CHARGES ARE GOING TO BE.

    THE HOSPITAL AND DOCTORS AND EVERYONE GET VERY DEFENSIVE AND DEFLECTIVE WHEN i TRY TO ASK ABOUT THE COST.
    iT IS LIKE THEY ARE OFFENDED AND TRYING TO HIDE SOMETHING.

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    • JAMES
      October 8, 2017 at 12:49 pm

      CORRECTED SOME SPELLING AND STUFF
      I cant help but feeling something is wrong with the PRICE VALUES assigned to medical care.
      I am 51 years old and went to the ER on Sept 8, 2017. I never go to the doctor and I don’t go to the ER unless it is necessary. I don’t have insurance because I have not worked in 10 years. I felt that morning on Sept 8 that I had to pee even though I knew I just went. The feeling was driving me up the wall. The level of being uncomfortable was to the extreme.
      So I went to the ER. If I had known at the end of it the ASSIGNED VALUE OF THE MEDICAL CARE would come to $20,407.90, I may have forced my mind to think of another solution, like trying to drink a lot of water abd see what happens.
      ER/HOSPITAL = 18,893.90
      ER DOCTOR AND A REPORT PERSON = 1001
      RADIOLOGY COMPANY = 513
      TOTAL = $20,407.90
      I look at that as I must be really sick or the system is sick.
      All they did was X-ray my stomach, an EKG, an enema, a ct scan of stomach, blood tests, IV water and IV antibiotics, urine tests, more blood tests, in Hospital room overnight to afternoon of the Sept. 9.
      I felt better after the enema but instead of writing a prescription for antibiotics and sending me home, they added on the catscan, hospital room, the IV’s, and more blood tests.
      At the end of the day I received over 20,000 dollars in healthcare at the hospital. To this day I do not understand if I am sick or not.
      I don’t understand why the cost is so high.
      The ER doctor charges separately and he is saying he wants $942 dollars.
      If 50 people came in the ER that Shift which is possible here, the doctor that I never saw and have no idea what he did, is making like 50,000 dollars a day.
      I’m sure there was at least 50 patients in there, it is a gigantic ER.
      How can an ER doctor be making a million dollars a month?
      SOMETHING IS OUT OF WHACK.

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      • Pat
        October 8, 2017 at 6:43 pm

        James, Were they able to help you with your dementia?

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        • JAMES
          October 9, 2017 at 7:42 am

          ATTACKING ME PERSONALLY SHOWS YOU HAVE NOTHING TO SAY. NO ARGUEMENT AGAINST WHAT I AM SAYING.

          YOU MUST BE A LIBERAL, CAUSE THAT IS RIGHT OUT OF THEIR PLAYBOOK.

          NOTHING CAN JUSTIFY THIOSE CHARGES.

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          • Steve O'
            October 10, 2017 at 11:25 am

            Prices are supposed to be measures of value, which they are in some economies but not others. In economies in which the government controls the markets, there is no such thing as price, really. Policy, not price, controls what is done. Should we burn coal, or use solar power? Neither one has a price which reflects the amount of effort needed to produce the energy. Since coal has, by far, the most BTU’s per unit of labor, then a government-controlled market would not pay much attention to solar, until the coal mines out.
            One way of handling medicine is using strict market-based forces. The patient pays the doctor, and the doctor renders services. If the doctor wants $1000 for a visit, just refuse. If another doctor wants $50 for the same service, that doctor will be flush with patients, and the high-priced one may be hanging out on the vine.
            Another way is strict Communism, which I would rather prefer. I will see any patient at any time for free! As part of my Hippocratic oath! Of course, for society to enable such powerful healthcare, my doctor’s license works the same at the car dealership, the grocers and PayPal. I should very much like to walk onto the car lot and select my car, paid for by the grateful community. I prefer a nice steak over some ground round, and cut it thick, butcher! And eBay – cost is no object!
            The problem is that somewhere, there is an oil-and-water interface between the ideal world and the market world. Now, the fault line runs right through the clinic. The doctors get paid what the insurance companies dictate. But if you then tell your custodian that you will decrease his fees by 10% – wait for the laughter! The stationers’ giving you a discount because you are a person providing valuable services to the community – a stare of incomprehension! Half-price on your next auto purchase – wait until they bring the butterfly net! Alas, Communism only works when it’s everywhere; and when it’s everywhere, nothing works.
            Only DPC can possibly work. If you hate your hospital charges, get behind DPC. If you receive an outrageous bill after the fact then, just say NO! The patient – and the doctor – are back in the drivers’ seat.

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      • Pat
        October 8, 2017 at 9:03 pm

        James, either you are mentally ill, or an idiot. But on the wild fantasy chance that you’re right, could you tell me WHERE they are paying ER docs $50,000 a day?? I would cheerfully work locums one day a month and sit on my ass for the other four weeks.

        And if you’re mentally challenged, then I apologize, and implore you not to post on sites where you will further embarrass yourself.

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        • Sir Lance-a-lot
          October 8, 2017 at 10:47 pm

          Pat, I think James’s math is okay, but he fails to see the whole picture.

          IF the hospital actually got the $942 it billed for the physician (which it does not), that would not affect the roughly $2,000 that the ER doc gets for his 13-14 hour shift.

          SO, IF the $942 billed is actually collected, then the doctor gets $2,000 and the hospital gets $48,000. It’s a sweet deal for someone, but not for the doctor.

          On a different note, next time you feel ill and don’t have insurance, go to an Urgent Care, rather than an ER. And, if you MUST go to the ER, don’t bring your wallet, and give them a false name and address – they are required by law to treat you, whether you can be identified or not.

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          • Pat
            October 8, 2017 at 10:53 pm

            Yeah, of course I know all that. But James sounds like the sort that would inflate a mild complaint prompting a Cadillac workup, and he sounds to me like the guy who would find a compassionate lawyer in the unlikely event of a serious problem or bad outcome.

            And even if his numbers are close, he is yet another who buys into the fiction of millionaire doctors as the average, further fanning his fuming.

            On the other hand, if there is a gig for $50K a day, I want to keep an open ear…

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          • Sir Lance-a-lot
            October 8, 2017 at 11:18 pm

            Pat, you used “compassionate” and “lawyer” in the same sentence.

            But otherwise, yes, I agree.

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    • Sir Lance-a-lot
      October 8, 2017 at 4:51 pm

      $209 for a condom?!?

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      • Pat
        October 9, 2017 at 8:32 am

        Yeah, because lawyers are our true healers 😉

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        • Sir Lance-a-lot
          October 9, 2017 at 10:22 pm

          Actually, I think that’s what they charge you for one before they bend you over.

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  3. barb
    October 8, 2017 at 12:36 pm

    ER is for life threatening emergencies. Med Plus for all else. Lesson learned?

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  4. October 8, 2017 at 10:48 am

    I can’t help but picture Hulk Hogan being mad at Macho Man or Paul Ryan being mad at Nancy Pelosi when I read that a govt approved panel is mad at a govt agency. Whether its Jim McMahon, K street, or Crony Crapitalists; the ones writing the checks for both ‘sides’ are the same. You have to show a little flare for drama now and again to keep the viewers watching.

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