Nice MIPS

I just found this ripped out article that I never blogged about. It turns out that nearly 20% of small/solo practices took a pay cut in the first year they participated. How many government workers took a 20% cut? How many insurance company CEOs took a 20% cut? The truth is that they want to kill the solo doc. if you are one and want saving then you want DPC.

Just sayin’.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Nice MIPS

  1. Jennifer Hollywood
    October 22, 2019 at 7:29 am

    You can be exempted from MIPS if you keep your Medicare numbers low enough. In addition you should run the numbers. Example. If you get $50,000 from Medicare then a 1% pay cut is $500. How much time and money do you spend to report and how many actual dollars do you save? Is it worth it?

  2. Pat
    October 21, 2019 at 6:07 pm

    Any new primary care doc NOT going into DPC should only consent to work for an hourly wage, and even then, that’s just staving off the wolf. I really feel for the older docs stuckk with this. Newer docs entering into this crap deserve exactly what they get.

  3. Rando
    October 21, 2019 at 3:24 pm

    When the MIPS program was first being implemented CMS’s own predictions were that 90% of solo practices would take a pay cut, so they may see 20% as a success. The trouble is that in a large group they will just hire somebody to take care of the MIPS BS for all the physicians, but in a small group that is much more cost-prohibitive. The end result is that many small practices either don’t do it very well or at all. I expect the number of penalized practices will get bigger, as some of the measures CMS took to help smaller practices will be phased out.

    I’m a solo FP and estimate I spent 40 hours working on MIPS in the first year. Now that I have some processes set up it’s not as much but it’s still a big time commitment, probably in the 10-20 hour range. I spend about $400 yearly on a Registry to report to CMS, then of course there is employee time and decreased efficiency which is difficult to track. I see a lot of Medicare and am in a smaller town, so DPC isn’t a very good option unless I move.

    I don’t think CMS intentionally wants to kill the solo doc but that is the ultimate effect of their policies.

    • Steve O'
      October 21, 2019 at 7:03 pm

      I don’t think CMS intentionally wants to kill the solo doc but that is the ultimate effect of their policies. Sorry, but I do.
      The solo doc is inherently unpredictable and unmanageable. They each believe they possess enough experience, skill and judgment to diagnose and treat the sick. In our ant-farm society where deviance is defective and dangerous, there is no way to whip the solo doctor into obedience to her/his bureaucracy – it simply does not exist! It is a serious deviation, not like sexism or racism or gender fluidity and jihadism, for those are all predictable. The independent mind is a far worse threat.

      • Rando
        October 22, 2019 at 2:13 pm

        Actually back at the time CMS was predicting 90% fail rate for small practices I participated in the formal commenting period and also contacted my Senators and Congressman. I ended up talking to representatives of both senators offices, one of which was a MD.

        My impression is they are just sort of clueless. They propose and vote for policies without thinking them through. Undoubtedly the larger health care corporations would like to see us gone, but I didn’t get that sense at the level I was involved in.

        Semi-related, when I was talking to the MD from the senator’s office she made some comment about how the AMA was involved in getting the SGR ended and was I happy about that. I was kind of taken aback and felt like saying “the AMA? Are you kidding me?” but stupidly mumbled something like “umm, yeah, good”.

        • R Stuart
          October 23, 2019 at 11:07 am

          The senators very well may have been clueless, but the AAFP sure wasn’t – they were fully aware how disastrous this bill would be for solo and small practices.

          It is impossible to overstate how much damage the AAFP has done to their own members as they fight among themselves to see who can stick their noses furthest up the asses of CMS and large insurers.

          • Rando
            October 24, 2019 at 9:51 am

            I can’t argue with that. The AAFP should definitely know better, but let’s get real – they couldn’t care less about private practices.

  4. R Stuart
    October 21, 2019 at 3:22 pm

    “nearly 20% of small/solo practices took a pay cut in the first year”

    That’s EXACTLY why the AAFP, doing the bidding of their corporate masters, supports MIPS so aggressively.

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