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    MACRA will not save money


    MACRA's 1,600 pages of new regulations increase the crushing burden of documentation without improving quality of care or reducing costs. Some of the best clinicians in my community are solo practice specialists I chose to treat me, based on my observations as a referring general internist. They have all complained to me that they have already been hit with substantial Medicare fines for non-compliance with the electronic health record (EHR) mandate, and now, MACRA. One of my doctors steadfastly refuses to abandon her neat, legible and well-organized paper charts. Another specialist made an expensive investment in an EHR, only to find that it was burdensome, interfered with patient care, distracted him from concentrating on important issues and was too costly. After one year, he fired his IT consultant and tossed the whole system out of his office. His brilliant and astute clinical care is not being assessed accurately by CMS. He will retire earlier than he had planned, because MACRA fines have cut his already thin operating margins.


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    When CMS Administrator Seema Verma was recently told by clinicians that her agency's regulations are too burdensome, her reassuring reply was that MACRA will ease that burden when it is fully implemented. Only a bureaucratic zealot could believe that adding 1,600 pages of regulations will relieve regulatory burden.

    The most significant improvement introduced in this year's MACRA update is that more clinicians will be exempted from its mandates. By that metric, MACRA can achieve its maximal improvement by exempting all clinicians from its regulations, I concur.

    We are told that an ever-increasing portion of each clinician's pay will be based on how low they can drive their average spending per Medicare beneficiary. That approach will definitely reduce the cost of the Medicare program, but I do not want to be treated by any doctor who is incentivized to reduce spending on tests and treatments. I do not want to be treated by a doctor whose hidden agenda is to save money on my care. I want to be treated by doctors who will offer me the most beneficial interventions for my condition, and my doctors should derive neither profit nor loss from the interventions they order.


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    Traditional Medicare incentivizes medical testing, in certain situations where a practice owns a lab or imaging facility. Again, doctors should never be financially rewarded or punished for the cost of care they provide. The cost of a patient's care should have an entirely neutral effect on physician income. Doesn't it make sense to get rid of rules that let doctors profit from ordering tests, before we adopt rules that levy fines on doctors for ordering tests?

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    David L. Keller, MD
    David L. Keller, MD is a retired internist who resides in Lomita, California.


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