Warning: This May Make You Sick    

   Okay, they didn't repeal Obamacare. How about repealing a healthcare law that hasn't yet taken effect? 

   The 56 million people on Medicare may not see the acronym MACRA on their bills, but doctors may have to hire more staff. If the U.S. eventually goes single-payer, this is a hint of government to come. 

   Four years ago, the Harvard Business Review identified 16 workers in healthcare for every doctor. Six of them take care of sick people. The other 10 work to satisfy government mandates. 

   That number is going up as doctors conform to MACRA's Merit-based Incentive Payment System (MIPS). This "negative payment adjustment" is government talk for carrots and sticks.

   Medicare reimbursement will depend on grades doctors receive in each of four categories. The American Academy of Family Physicians calls it, "pay for reporting, not "pay for performance." 

   We note that this Congress (Senate?) has done nothing to rework what hatched in prior years.

Category One: Quality. The goals are worthy, but the cost is a massive effort to report on six different measures on at least half the patients a doctor sees. 

   Researchers figure that medical workers in four common specialties already spend an average of 785 hours each year, per physician, just reporting "quality measures." 
(We think that means about 40 percent of their time is working for the government, not patients.) 

Category Two: Advancing Clinical Information. This mandates doctors replace paper charts with electronic health record systems (as some already do). Some patients - including us - are saying, "The doctor looks at his computer more than me."       
- Charles Horton, WORLD magazine

Tomorrow: Categories Three and Four

       Jimmy