As a physician in private practice I enjoys taking care of elderly patients. Because most retirees over age 65 who want to be insured have no choice but to enroll in the Medicare program, I have continued to cooperate with the program. Many of my physician colleagues have opted out of Medicare, and I wonder how long I can hold out. As I continue to be presented with new Medicare requirements, it appears I am being given two choices. I can continue to provide comprehensive, personalized care for my patients, or I can focus on the paperwork, mandates, and forms required to get paid. I am coming to the conclusion that I cannot do both.
The federal government wants to dictate what I do for my patients even if it might compromise my best judgment. I must trust the dictates of those who never went to medical school. They cannot possibly know what is best for the patient sitting in front of me. Will I allow my judgment to be clouded by those with the power to deny me payment if I do not comply with their "standards?"
The Medicare bureaucracy has come up with more hoops through which I must jump to avoid penalties. The Physician Quality Reporting System (PQRS) is a new entity that is another distraction. The following is just one example of jargon from the Medicare website:
PQRS has several methods in which measure data can be reported. An eligible professional may chose [sic] from the following methods to submit data to CMS: claims-based, registry-based, qualified Electronic Health Record (EHR), or the Group Practice Reporting Option (GPRO).
Eligible professionals who choose to report 2013 PQRS individual measures should select at least three clinically applicable measures to submit in an attempt to qualify for a PQRS incentive payment. If fewer than three measures are reported via claims, CMS will apply a measure-applicability validation (MAV) process when determining incentive eligibility. Refer to MAV information available in the "Downloads" section of the link titled "Analysis and Payment."
Still puzzled, I clicked on "Measures Codes" to see what they are trying to have me measure. I already measure height and weight, blood pressure, and blood tests. There apparently is more.
The PQRS measure documents for the current program year may be different from the PQRS measure documents for a prior year. Eligible professionals are responsible for ensuring that they are using the PQRS measure documents for the correct program year.
After reading this, I am very glad I did not check this out last year, for if I do things this year in the same way as last year, this year I would be incorrect and would face a penalty. But what do they want?
By October 2014, we are expected to be using the new updated ICD-10 codebook of diagnoses, adding new digits, numbers, and minutia to our recording of what ailments or injuries befall our patients. Our current EMRs will need to be completely revamped if we want them to accommodate these new codes, and the cost to do this might be impossible for a solo practitioner to afford. Only physicians who are part of large groups or hospitals will be able to survive, as these issues can be magically handled by trained, well-paid coders.
I have already been told that my payments are being cut because I am not sending my prescriptions to the pharmacies electronically. It is not at all clear to me why the government has a vested interest in such technology, but perhaps it is related to the fact that they want me to put my electronic medical records online as well. But that is a red line that I will not cross, as my reading of the Oath of Hippocrates tells me that I ought not divulge private medical information to others. My records are useful for me to better care for my patients-not data to be mined by people far away.
PQRS, EMRs, and ICD-10 might be the final wedges that push physicians away from the Medicare program.
But if I opt out, I will be available to those who still value my judgment and are willing to pay me a fair fee for primary care.