Viewpoint

Too many qualifiers

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

Sometimes I stare at my computer screen, trying to choose a column idea to share with you. But when many issues qualify in tandem, like now, I can’t select just one. So brace yourself — this month I’m sharing them all.

Up first, a perennial favorite, CMS. The good but often misguided folk there have a “demonstration plan” in the works that would reward you for using less expensive drugs and penalize you for using the more expensive variety. To CMS and groups like AARP, this sounds like a good idea, as it does to my fiscally conservative self. When there is a choice between $50 Avastin and $2,000 Lucentis or $1,800 for Eylea, studies clearly bear out that the higher-priced drugs are usually not as cost effective. So I almost always recommend a trial with Avastin first. However, many patients under-respond to the less expensive drug, responding much better to the higher-priced meds. So what will the doctors do under this new plan? Give patients the medicine that’s proven to work better and can save a patient’s sight, or lose money every visit that the patient shows up? (tinyurl.com/hfd9o85)

Second, MACRA, QPP, MIPS and APMs, brought to you by — you guessed it. These acronyms stand for new programs like Alternative Payment Models and Quality Payment Program, which will determine in large part how much you get paid over the next few years via a series of bonuses and penalties. Understand that the government has decided it will pay you more or less based on perceived value. One tiny problem is that this system is untested, and so far, we don’t have much evidence it will help with patient care or outcomes, much like the last failed government creation using EMRs with the “meaningless” use feature. Another major concern with this acronym alphabet soup is that we are not going to learn the final rules until sometime this month — but the rules become effective in January. So one of the largest reimbursement changes ever undertaken begins a few weeks after you learn what the rules are. (tinyurl.com/hrc2eb8)

My final diatribe is against the Health and Human Service’s Office for Civil Rights. Did you know that doctors are such horrible abusers of their patients’ civil rights that HHS developed a massive bureaucracy with taxpayer funding to keep us in line? While details are still hard to come by, what is known is that this office has decided you must post notices of nondiscrimination in your practice to alert individuals with limited English proficiency as to the availability of assistance services in their language.

So not only must you provide said services, you must pay for them. That means a patient coming to see you who speaks poor English and is charged a $40 office exam may cost you $100 or more to provide these language services. Don’t get me wrong, I’m all for helping my patients in any way I can. But how I would have found, much less paid for, the translation services for the Iraqi patient visiting last week here in rural Tennessee, I’ll never know. I’m waiting for a large, unsavory practice to distribute flyers in a limited-English neighborhood to advertise the free translation services of his or her competitor. (www.ascrs.org/node/27932). OM