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A year ago HHS Secretary Sylvia Burwell announced that Medicare would be dramatically altering the way doctors are paid. She stated that starting in 2019 physician and NP salaries will be based on Quality and Value, a very noble proclamation that, on the surface, sparkles of a transformative change in the landscape of health care. At the time of her announcement I wrote an op-ed in the Baltimore Sun (CLICK HERE for a link to the article) questioning how CMS intended to define the words Quality and Value. Now that Medicare has introduced its product in a 900 page memo, the meaning of quality and Value has been delineated. And in a page out of George Orwell’s 1984, the two seemingly innocu
There is no question that CMS has every right to demand better value in health care. Medicare’s coffers are being drained, as a significant amount of funding is being spent on fruitless efforts to keep people alive in their last weeks of life, on expensive tests and procedures that have no proven efficacy, on needless hospitalization, and on a proliferation of specialization that increases cost with worse outcomes. The Institute of Medicine estimated that in 2009 there was $750 billion of waste in medical care; it is felt to be approximately $1 Trillion now. A quarter of Medicare’s budget is spent on end of life care, and while the average Medicare recipient puts $88,000 into Medicare, he
How can quality be measured in health care? Certainly Medicare feels that they have the answer. Half of primary care doctors’ MIPS grades will be based on how we prove that our care is “quality” care. And since our grade will determine our salary, this stuff is really important. You may think that if we are taking good care of our patients based on their individual wants and needs, if we take time to talk to them about their medical problems, if we avoid overtreatment and drugs with excessive side effects, and if we use the best data available to work with our patients to make shared decisions, then we are practicing quality care. But in fact, this approach is the very antithesis of Med
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