Finally, legislators are taking notice of the abuse of MOC in Florida and proposing laws to stop it. Representative Dr. Julio Gonzalez (Venice) and Senator Jeff Brandes (Pinellas County) have each sponsored legislation to help doctors and the patients they serve. The bill in the House is HB 723 and the Senate Bill number is pending. The efforts of the AAPS Florida chapter brought these bills to fruition.
The MOC control bill would do the following:
1. Prohibit MOC for Florida Medical License
2. Prohibit mandatory MOC participation for membership on hospital medical staff.
3. Prohibit mandatory MOC participation as condition to be included in Insurance physician panel.
As President of the Florida Chapter of the AAPS, I submitted comments today to the Centers for Medicare and Medicaid Services on their proposed “MIPS” rules. MIPS (Merit-based Incentive Payment System) is an onerous command and control structure for doctors using financial and administrative penalties to coerce medical practice away from the interests of individual patients and toward the interests of government and corporate third parties. The law that allows the Obama administration to create MIPS was called MACRA (HR2) and passed last year with the full and enthusiastic support of the AMA and 49 of 50 state medical societies (only New York refused to support it).
These rules will harm patients and their doctors, placing a wedge between them that will break the most critical bond of the patient-physician relationship: trust. Patients will now wonder, “Is my doctor withholding medical care simply to obtain a government bonus?” Patients will ask, “Is my doctor giving me the best care for my individual needs in his judgment or simply following a government cookbook to serve another master?” Doctors will ultimately wonder, “Why did I try to get the bonus, instead of simply taking care of my patient?”
Excerpts of the comments are reproduced below and the full letter, with detailed references to exact rule and law language is available for download here.
“Comments by Florida Chapter, Association of American Physicians and Surgeons and David McKalip, M.D., June 24, 2017 on MIPS Rules pursuant to MACRA”
“We (AAPS-FL and David McKalip, M.D.) write to point out that the proposed rules are an invalid exercise of delegated parliamentary authority. They are written in an arbitrary and capricious fashion and violate applicable administrative and other law. They are over-broad and will cause harm to physicians and their patients. These rules would cause patients harm by 1) causing physicians to alter practice patterns to satisfy the rules to achieve a bonus, avoid a penalty or avoid other harm to their practices and 2) interfering with the ability to practice medicine independently and in the best interest of their patients. The rules will cause substantial and unacceptable unfunded expenses and burdens on physician practices and deprive physicians of their time with patients since they must instead be coerced to spend time on onerous compliance activities.”
“(1) Mandatory Participation is unlawful.
There is a glaring and obvious violation of the law. The rule states that all MIPS eligible clinicians “MUST” (emphasis added) submit data and more.
“§ 414.1325 Data submission requirements. (a) Data submission performance categories. MIPS eligible clinicians and groups must submit measures, objectives, and activities for the quality, CPIA, and advancing care information performance categories.”
The law authorizing these rules (HR2, 114th Congress, “MACRA”) specifically denies the ability of any agency of the government to require submission of any data under MIPS. Title I, Section 101 indicates that participation in the MIPS program is completely voluntary. Page 41 of HR2 (as published by the GPO) indicates that Title I, Section 101, (c)(1)) amends Section 1848 of the Social 7 Security Act (42 U.S.C. 1395w–4) and adds the following language:…”
“The rules do not Improve physician payments and make payment to physicians harder to obtain for their services to patients. The rules impair the ability of physicians not only of maintaining a cost-effective practice, but of practicing medicine at all in the manner in which they see fit, especially in a private or small practice. This violates Section 1801 of the Health Insurance for the Aged Act that says “Nothing in this [subchapter] shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services….” (Title 42, Section 1395, USC).
In addition, the rule harms access to care by Medicare patients by creating compliance protocols that are primarily based on cost of care and administrative factors. These rules specifically refer to a budget neutrality goal. The rule refers to withholding “incentives” from doctors who do not obtain arbitrarily defined budget and spending goals that can only amount to a rationing of medical care. Furthermore, physicians are coerced to comply with so called “quality measures” and are penalized for not obtaining arbitrary compliance thresholds set by the government and these rules. Such compliance fails to recognize the unique needs of individual patients, including those covered by Medicare. This amounts to a “one-size-fits-all (or most)” program that denies the specific medical care required by individual patients at different times in their lives based on the training, experience and judgment of the patient’s physicians. In addition, compliance with such measures has been specifically shown, in valid scientific studies, to directly injure or cause death to some patients and interfere in access to care for higher risk and other patients. Such programs do not increase access to Medicare, but decrease it, and these rules thus fail to comply with the law as proscribed by Congress.
We suggest modifying these rules substantially to address these and many other concerns. The MIPS program should not be implemented by the administration as currently envisioned by the proposed rules.
David McKalip, M.D.
Independent Neurological Surgeon
President, Florida Chapter of the Association of American Physicians and Surgeons”
The Florida Medical Association joined the vast majority of medicine in signing on to MACRA. MACRA is a massive intrusion into the patient-physician relationship that claims to be about quality and proper resource use. MACRA is really about finding an excuse to not spend money on Medicare patients. This is because the false political promise of government funded medical care for the elderly is failing. MACRA merely creates a penalty system designed to turn doctors into rationing agents for the state – turning them against their patients.
Prior to passage of MACRA, the AMA was leading a campaign to get all state and national medical associations to sign on. As an officer of the FMA at the time, I was working overtime to get the FMA to say “no”. Only the Medical Society of the State of New York refused to sign and they have since been proven right to do so.
Here is the white paper I prepared to try to get the FMA to say “no” to MACRA (Evaluation of HR2_budget neutrality). Sadly FMA President at the time, Dr. Alan Pillersdorf, violated FMA policy and went well outside his powers as President to unilaterally – with no vote of the FMA Board – to agree to sign on to MACRA.
The AAPS is working hard to protect patients and doctors from this final government take over of the entire medical profession. We need your help to fight. Please join today.
Dr. Edward Annis videos from Ed Annis Medical Freedom Award Presentation Event. These videos describe his heroic work, in his own words, even though the humble Dr. Annis would never accept a title of “hero”.
Dr. Edward Annis was a legend in medicine and medical freedom.
In 1962, the first attempt to pass Medicare failed when Florida surgeon Dr. Edward Annis addressed the nation. He as met with President Kennedy who, many say inspired by Annis, gave the worst speech of his Presidency on the matter at Madison Square Garden (on purpose). A Few days later, Dr. Annis addressed the empty venue…
“This Bill (King Anderson Bill) would put the government smack into your hospitals! Defining services, setting standards, establishing committees, calling for reports, deciding who gets in and who gets out-what they get and what they don’t-even getting into the teaching of medicine-and all the time imposing a federally administered financial budget on our houses of mercy and healing. It will create an unpredictable burden on every working taxpayer. It will undercut and destroy the wholesome growth of private voluntary insurance and prepayment health plans for the aged which offer flexible benefits in the full range of individual needs. It will lower the quality and availability of hospital services throughout our country. It will stand between patients and their doctors. And it will serve as the forerunner of a different system of medicine for all Americans.” Dr. Edward Annis, Madison Square Garden,1962.
I am happy to report that because of your support, the Florida chapter of the Association of American Physicians and Surgeons is up and running. We are in a position to make medical practice in Florida great for physicians and patients – despite the overbearing posture of the government, insurance companies and hospitals. We have it in our power to save the medical profession. Our chapter will be working to providing education to our members on how to set up practices that thrive, working to promote freedom and choice in medical care and will be advocating for you in Tallahassee, the private sector and through media outreach. We will need your continued support to do so. Soon we will be launching a voluntary fundraising drive for our chapters. There will be no dues and no arm twisting, just give what you can. More importantly, we will be counting on you to help us grow as a chapter by recruiting new AAPS members, helping us in committee work and hosting us in regional meetings of our state chapter. The future is bright with AAPS-FL and on behalf of our new board, I thank you for your continued membership and involvement!
Rebekah Bernard, MD, author of How to Be a Rock Star Doctor: The Complete Guide to Taking Back Control of Your Life and Your Profession. See her open letter to her Medicare patients and CLICK HERE to get your copy of her must-read book today.
AAPS-Florida Chapter Board Meeting6/25. Members invited.
Members of the AAPS who reside or practice in Florida are invited to the Board meeting of the Florida Chapter of the AAPS. The meeting will be held at the Heart of Florida Regional Medical Center in the Kissimmee area (40100 Highway 27, Davenport, FL 33837).
The meeting will be from 10 am to 4 pm on Saturday, June 25th, 2016.
Members are asked to RSVP to Chapter President, Dr. David McKalip at email@example.com (727-822-3500). Only members who have up to date dues paid to the national AAPS organization are invited to attend the meeting.
The meeting will discuss the past and upcoming Florida legislative session, chapter growth, issues for advocacy and ways to serve our members. Leadership opportunities exist for committees that will be forming.
TWO January 2016 Florida AAPS Events
Check out these TWO January AAPS Florida events you WILL NOT WANT TO MISS as well as an important video message from the Florida Chapter.
1. Teleconference on Wed. January 13th, 5:30pm Eastern, with MD author on Practice Prosperity Outside the System. 1/13/2016, 5:30, P.M. Exclusive to AAPS-Florida Chapter members.
Talk with, Rebekah Bernard, MD, author of How to Be a Rock Star Doctor: The Complete Guide to Taking Back Control of Your Life and Your Profession, see her open letter to her Medicare patients.