Rock Star Physician Rebels Against Medicare Bureaucracy

Rebekah Bernard, MD, who wrote a book titled How to Be a Rock Star Doctor: The Complete Guide to Taking Back Control of Your Life and Your Profession, has written an open letter to her Medicare patients. Here are the choice bits:

For every office visit that we spend together, I spend at least as much time on what Medicare deems as necessary documentation, especially a new program called meaningful use.

To comply with Medicare requirements, I’ve had to spend thousands of dollars and massive amounts of time instituting electronic health records, adapting my practice to conform to the computer technology that wasn’t created to help me, your physician.

And next year the whole ballgame changes for physicians as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) goes into full effect, with a complete paradigm shift in Medicare payment from “fee-for-service” (I send a bill for your medical care, Medicare pays me), to “value-based payment” (I submit a bill, and I get paid if Medicare thinks that I’ve done a good enough job).

The kicker is that the pot of money remains constant—so even if every doctor makes an ‘A’ grade, half of them will be paid less money, just by nature of this “budget-neutral” payment system.

Up to this point, I have managed to play by the rules that Medicare has set.

In 2017, this may no longer be the case.

As a policy analyst, not a physician, I have to report a mixed response to this letter. I have great sympathy for the message: It hits two policy issues that I have addressed forcefully: so-called Meaningful Use of Electronic Health Records (EHRs) and the fundamental reforms to physician payment in this year’s “doc fix” legislation, MACRA.

Meaningful Use of EHRs refers to the $30 billion of taxpayers’ money that was flushed away on EHRs that are (at best) ineffective at improving the quality of care. Rebellion against the program has increased since the money was paid out, and it should be abandoned.

MACRA was a disgracefully bipartisan bill that was rushed through Congress by physicians’ professional societies, which effectively sold out their members in order to increase the societies’ power over payments. Practicing physicians had no time to organize themselves to respond. It is good to see them finally pay attention.

On the other hand, physicians cannot just complain about how little Medicare pays them. Medicare is in a fiscal crisis and doctors who think they can go back to a time where their claims were just processed without question have unrealistic expectations. Unless and until they accept that giving Medicare patients power over medical prices and payments is the only way to reduce government bureaucracy, their Medicare problems will get worse.

Further, the threat to quit Medicare next year is one which I have heard physicians make for about 15 years. Although more physicians have recently dropped out, the number of physicians treating Medicare patients is growing in line with the number of Medicare beneficiaries, according to a recent report by the Medicare Payment Advisory Commission (MedPAC, see page 80).

In other words, the signal to noise ratio for physicians’ frustration with Medicare is very low. Until that changes, we can expect government to continue stumbling and bumbling around the program.