Everybody Gets A Medal: Budget Busting Performance “Incentives” In Medicare Reform

Confident DoctorsIn April 2015, huge bipartisan majorities passed a milestone Medicare reform bill called MACRA, which imported all the worst elements of Obamacare into Medicare. At the time, I wrote an alternative proposal, and anticipated physicians would refuse to swallow the medicine MACRA prescribed. Congress passed the flawed MACRA bill, and President Obama gave a speech describing how “this legislation builds on the Affordable Care Act.” Remarkably, Republican politicians who assert they want to “repeal and replace Obamacare” have still not recanted their support of MACRA.

The gist of MACRA is that Medicare will no longer pay for “volume” but “value” in a zero-sum game wherein physicians who do not satisfy the government’s requirements for “value” transfer income to those who do. Since the bill was signed, the details have percolated from the elite physician executives who run the medical societies which lobbied for the bill down to practicing physicians. There has been pushback.

Nervous that physicians will bail out of Medicare if the government squeezes them too hard, the Administration has backtracked on MACRA’s sticks and shifted towards carrots. Last April, the Administration published a proposed rule, 426 pages long. After a lengthy comment period, the final rule, which is 2,205 pages long (!), was published on October 14.

According to the proposed rule, 761,342 physicians were expected to participate in the Merit-based Incentive Payment System (MIPS) in 2017 (Table 64). Almost half (45.5 percent) were expected to be docked pay for underperforming while 54.1 percent would be rewarded for over performing, and a very small number would be neither penalized nor rewarded. $833 million would be transferred from the under performers to the outperformers. To give a little boost to the incentive for the first year, another $500 million would be handed out to the outperformers.

According to the final rule, up to 642,119 physicians are expected to participate in MIPS in 2017 (Table 62). However, only 5.3 percent will be penalized for underperformance. They will be docked $199 million, while the vast majority will get bonuses of $699 million (plus the $500 million extra in the first year).

In conclusion, the taxpayers’ liability doubled from $500 million to $1 billion in just six months. That is not a big amount of money, but it should be an affront to those who still cling to the quaint notion that Congress should appropriate money for public spending. And by giving bonuses to almost 95 percent of physicians, the final rule ridicules any conceit the legislation had of rewarding top performers for quality.

Comments (5)

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  1. Lee Benham says:

    As Hillary once said “what differance dose it make”?
    We are already $20 trillion in debt that can not be paid back so why not just keep printing money and handing it out? If we can’t pay the $20 trillion what differance does it make if we raise the debt to $30 trillion by the end of Hilary’s first term?

    I’ve switched my support vote Hillary ! What’s Madonas phone number again?

  2. John Fembup says:

    “I’ve switched my support vote Hillary !”

    Lee, you sure you want to do that?

    you’re risking the wrath of Senator Foghorn Leghorn!

    • Ron Greiner says:

      If Madonna is “buying” votes you know that’s illegal Lee.

      That Chicago guy, Creamer, that went to the Obama White House 342 TIMES, wrote how to pass Obamacare while in prison. YOU know – James O’Keefe put him in that new video and he is fired and now famous.

      Obama strategist [[David Axelrod]], who noted that Creamer’s tome “provides a blueprint for future victories.”

      In the book, Creamer draws lessons from decades of experience on the radical left, including the teachings of arch-radical Saul Alinsky, and several episodes from Rep. Schakowsky’s political career. He also lays out a “Progressive Agenda for Structural Change,” which includes a ten-point plan for foisting universal health care on the American people in 2009….


      “We must create a national consensus that health care is a right, not a commodity; and that government must guarantee that right.”

      “We must create a national consensus that the health care system is in crisis.”

      “Our messaging program over the next two years should focus heavily on reducing

      the credibility of the health insurance industry and focusing on the failure of private health insurance.”“We need to systematically forge relationships with large sectors of the business/employer community.”

      “We need to convince political leaders that they owe their elections, at least in part, to the groundswell of support of [sic] universal health care, and that they face political peril if they fail to deliver on universal health care in 2009.”

      “We need not agree in advance on the components of a plan, but we must foster a process that can ultimately yield consensus.”

      “Over the next two years, we must design and organize a massive national field program.”

      “We must focus especially on the mobilization of the labor movement and the faith community.”

      “We must systematically leverage the connections and resources of a massive array of institutions and organizations of all types.”

      “To be successful, we must put in place commitments for hundreds of millions of dollars to be used to finance paid communications and mobilization once the battle is joined.”

      Creamer adds : “To win we must not just generate understanding, but emotion — fear, revulsion, anger, disgust.”

      Democrats have followed Creamer’s plan to the letter. They have claimed our health care system is in crisis despite polls showing the overwhelming majority of Americans are happy with the care they receive.

      Read more: http://www.americanthinker.com/articles/2016/10/clinton_thug_robert_creamer_planned_obamacare_in_jail.html#ixzz4NwLob5Pm

      Barry bought the LIE hook, line and sinker and he thinks Healthcare is a right – hahaha