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Medicare Pay for Performance—Fighting a War That’s Already Over

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new-logo25Gerard Gianoli, M.D., F.A.C.S.

“In 1814, we took a little trip, along with Colonel Jackson, down the mighty Mississip….”

Like any good student growing up in New Orleans, I learned about the magnificent victory of the U.S. forces over the British in the Battle of New Orleans during the War of 1812. Of course, the Treaty of Ghent ended the War of 1812 before the Battle of New Orleans was even fought. Many have argued that the battle was useless since the war was already over. However, this is not the first or last time that governments have pursued “useless” enterprises.

Government central planning fosters this type of ineptitude. By its design, government is a slow-moving entity that often makes changes only long after that change has become obsolete. This is the nature of government, and it does not matter whether the occupants of the Oval Office or Congress have an “R” or a “D” after their names.

Recently, legislation passed as part of the “Doc Fix” (repealing the “SGR” physician pay cuts) institutionalized a physician Pay-for-Performance (P4P Medicare program called Merit-Based Payment Incentive System (MIPS).) The idea is to pay bonuses to physicians providing higher quality care.

Let’s make the highly dubious assumptions that government can measure quality in medical care and that such a system won’t just lead to “cherry picking” of patients. MIPS still won’t work to identify and reward “quality” physicians with bonuses. Why? Like in 1814, the government is fighting a war that is already over. More

The ‘Doc Fix’ and the End of Medicare

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new logo G. Keith Smith, M.D.

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The “permanent” end to the yearly threatened cuts to doctors’ pay—the sustainable growth rate (SGR) formula—may satisfy my curiosity about what the end of a Ponzi scheme will look like.

All Ponzi schemes are unstable and doomed to fail. Medicare and Social “Security” will be no different.

The yearly postponement of SGR cuts was a bribefest held to tease and extort corporate health cronies and physicians. The “doc fix” was not an exception: just look at all the “stakeholders” acknowledged in its 263 pages.

The purpose of the SGR was to delay the bankruptcy and end of Medicare. The doc fix will hasten it.

Central to the progressive goal of controlling the practice of medicine—and to the success of the [Un]affordable Care Act (UCA)—is the need to push physicians into employment contracts with hospitals. As hospital employees, doctors are easier to control, and less able to act as uncompromising advocates for their patients.

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