I have to admit that I have a lot of respect for Andy Slavitt. He’s doing a really hard job as Acting Administrator of CMS and he’s been very vocal and open about his view of what they’re doing and their efforts to listen to those of us in healthcare. I’ve really appreciated his willingness to engage the community on challenging topics. Did you ever see this from previous CMS administrators?
This tweet illustrates Andy’s efforts to really listen to doctors when it comes to MACRA:
On #MACRA…..We've now conducted 134 physicians events around the country! And we've trained nearly 60,000! 13 more next week!
— Andy Slavitt (@ASlavitt) June 9, 2016
This illustrates why I previously wrote that Andy Slavitt was very much in touch with the pulse of what doctors are feeling and experiencing. Although, with that comment I also said that I hoped that the policies and programs they implemented would match that understanding.
I realize that this concept is much easier said than done. Andy Slavitt and his team at CMS are sometimes not able to make changes to things like MACRA even if they know it’s the right thing to do. They aren’t the ones responsible for making the legislation. Their jobs are to implement the legislation. It’s a tough balance which always leaves people wanting.
The only thing awkward about Andy Slavitt’s tweet above is that he says CMS has “trained nearly 60,000.” It’s quite interesting that he views these MACRA sessions as trainings. I thought they were more listening sessions than training sessions, but I guess I was wrong. Certainly you have to train a doctor on the MACRA legislation if you want to get the right feedback from them. So, I guess training and listening aren’t mutually exclusive, but it’s not surprising that many doctors don’t want to be “trained” on MACRA. For some doctors, anything less than a full repeal of MACRA will be less than satisfying and that’s not going to happen.
While you can complain about the way Andy might phrase things in a tweet, I don’t think that’s very productive. Although, I don’t think listening to (or should I say training) 60,000 physicians’ thoughts about MACRA is very useful either if we don’t see that feedback incorporated into the final MACRA rule. This tweet gives me some hope that the feedback has been heard and we’ll see some important changes to MACRA:
Appreciating all the feedback– including negative. Appreciate solutions & ideas to address concerns even more. (2)
— Andy Slavitt (@ASlavitt) June 10, 2016
When the MACRA final rule comes out, I hope that along with the changes that were made we also get a look into the changes that people requested that CMS was unable to make because of the way the legislation was written. I’m not sure if CMS is allowed to be that transparent, but if we’re going to help push for better legislation it would be great to know which feedback was thwarted by legislation so that doctors can push for better legislation.
First of all, Andy does a great job “saying” he is listening or training or whatever his code is for this. I also think he “thinks” he is listening. But in reality, I think that the MACRA policy is set in stone. There is very little chance for any change. Any change at all would require yet again, another rewrite of code with 8 weeks to implementation. But I do recommend that everyone comment on it, as nearly all are negative. And very negative. I find it particularly distressing that CMS wants all this data, even on non-CMS patients, and we are yet again subjected to all this counting, numerators, denominators, arcane rules, auditing, confusion, etc. Has there been 1 study that has shown that MU did anything to improve safety security efficiency and satisfaction of the patient AND the provider? The amount of damage to the profession is almost unmeasurable. The burdensome regulations have damaged the CMS-provider relationship beyond repair. I am still dumbfounded that they want to continue MU with a new name and continued counting, and added in Clinical Practice Improvement..seriously? Jesus. I feel that CMS will blame the legislation and say that they are boxed in by that, and they cannot change the program due to that. The practice of medicine has been so heavily destroyed that I have my doubts if it will ever recover. It is blindingly obvious that CMS wants everyone to be in a huge group so they can collect data at will, and continue the barrage of regulatory action that will further kill it. I have suggested that they consider trying a separate non-penalty track. Let those that want to opt out, opt out. If you show that I cost the system more, then penalize me, if not, leave me alone. If they want to experiment with all this other AAPM and MIPS crap, then let those fools try it. But leave those of us that are doing quality low cost work alone. Or at least let those with less than 10-15 providers opt out. As I have said before, per Propublica, our group is the lowest cost, highest quality group in Ohio for total knee and hip and yes we are penalized by CMS because we do not do MU. So you want me out? I cannot count on my hand how many excellent providers I know that have given up completely on medicine because of all this complexity. Too many. Way too many. If that is the idea, then fine, drive us out. But don’t ask me to come back. Once I’m out, I’m out.