MIPS or ACO - them's your choices, Doc

I'm glad we have the likes of James C. Capretta to be willing to employ his brainpower in the service of parsing the arcane weeds of gummint health-care machinations.

He says we should look for the Senate to pass the Medicare-physician-payment legislation recently passed by the House.  The main reason will be that it removes the perennial thorn in their sides known as doc fixes.

But what it creates in the process is yet another layer of acronym-saddled pointy-headedness designed to make the average doctor's and average patient's eyes glaze over, so that they throw up their hands and say to the agents of Leviathan, "Just put me in whatever is simplest!"

The heart of the bill is a new, two-tiered indexing system for physician fees. Physicians who agree to participate in Medicare Accountable Care Organizations (ACOs) — or in similar structures established by the Medicare bureaucracy — will receive a permanent 0.75 percent increase in their fees each year. Physicians that don’t join an ACO will be placed into a new Merit-Based Incentive Payment System, or MIPS. Under MIPS, the Medicare bureaucracy will assess the “quality” of a physician’s services to patients and reward or penalize them accordingly. On average, physicians in MIPS will receive a payment increase of 0.25 percent every year — far below the annual payment increase for physicians in ACOs. The actuaries who assess Medicare finances for the administration have looked at these provisions and come to the perfectly rational conclusion that physicians will have little choice but to join an ACO to get an extra 0.5-percentage-point bump in their payments every year. By 2019, the actuaries assume that 60 percent of all physicians taking care of Medicare beneficiaries will be part of an ACO, up from 25 percent today. By 2038, they assume that 100 percent of physicians participating in Medicare will be a part of an ACO or a similar structure invented by the Medicare bureaucracy.

These ACOs are supposed to offer super-streamlined, breathtakingly efficient service to the cattle-masses - who won't even know that they've been corralled into them.

In effect, Medicare beneficiaries are being shoved into managed care–like structures without their explicit consent.

The bottom line?

It forces physicians into a new structure — ACOs — that gives the Medicare bureaucracy immense regulatory power over how doctors and hospitals organize themselves and take care of patients. And it forces Medicare beneficiaries to get their care through these organizations regardless of their personal preferences. Once established, ACOs will provide a direct route for the federal government to exert full control over the practice of medicine.

The free-market solution to this would be elegantly simple, and would probably come up with what this bill claims to come up with: a genuinely efficient managed-care model.  it would just be done as a result of the competition of ideas.

But simplicity is of no benefit to the Freedom-Haters.  Our overlords have a vested interest in bureaucratic mazes.  Your job, Comrade Cow, is to line up at this chute and get ready for the pen.