AAPS physicians threaten to leave Medicare because of MACRA

The Association of American Physicians and Surgeons warns physicians may make like the British and leave Medicare Brexit-style due to the "imposition" of new payment methods.

At issue specifically with the national group is the Medicare Access and CHIP Reauthorization Act, which replaced the Sustainable Growth Rate formula, and will determine physicians' Medicare payment adjustments beginning in 2019. This law would burden independent physicians specifically, AAPS said, citing data from CMS that predicted 87 percent of solo practice physicians would be penalized in 2019 under the law's Merit-based Incentive Payment System.

"Physicians need to withdraw from Medicare or any other program that subjects them to this rule," AAPS executive director Jane Orient, MD, said in a statement.

The AAPS takes issue with the rule's compliance score, which is tied to resource use and mandatory government-certified EHR use. This will pressure physicians to weigh the cost of resources against what is best for the patient, and the EHR mandate would give the government increased access to patient medical records, AAPS argued.

"It is impossible to practice medicine under this rule, for ethical and practical reasons," Dr. Orient said in the statement. "The rule makes it impossible to protect confidentiality, and one is in a constant conflict of interest: What is best for the patient may be bad for the financial viability of the practice. It would take a dedicated team of legal specialists to even attempt compliance. Full compliance is probably impossible even with such a team, which is beyond the means of a small practice."

The group also warned that the rule is not just for Medicare — it also allows all payers to be phased into the payment models, which AAPS calls "harmful."


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