President’s Message 5/10/16
A year ago in April, 2015 Congress passed and the President signed the repeal of the SGR formula doctors have lived with for decades. SGR was never really enforced however, since each year Congress passed temporary delays in its implementation and kicked the can down the road. Medicare participating doctors did not usually get any rate increases, but at least the draconian rate cuts the SGR would have mandated were usually blocked. The permanent repeal of SGR was hailed by many as a great advance since it directed CMS to devise ways for doctors to get paid not by the visit, but by our results. However, it still mandated that the new procedures be “budget neutral”, so there will have to be as many losers as winners. If patients were kept well and out of the hospital where the huge costs reside, doctors were to be paid more and paid less if not.
The new law is called the Medicare Access and CHIP Reauthorization Act (MACRA). If you want to read the law, it is not that long, here it is: https://www.congress.gov/bill/114th-congress/house-bill/2/text .Enjoy.
Trouble is there are lots of ways to implement such a plan. With Obama’s CMS troops in charge of writing the new rules, the expected happened. CMS has written a 960 page rule, many times longer than the Act itself, that nobody likes. It will force doctors into large groups and ACOs because small organizations cannot possibly comply with its complex reporting regulations. It will kill insurance and Medicare payment based solo and small group practice which will be totally unable to comply and will lose 9% of its revenue for failing to do so. Such practices are already running on very narrow margins with 70% plus overheads and a 9% cut will put many of them out of business and force the rest into contractural arrangements with hospitals that protect them at the price of dictating what they do.
The real irony is that clearly, solo and small group practice are the practices that are currently doing the best job of keeping people out of the hospital and out of emergency rooms. Why on earth would Obama’s CMS what to kill them. (In fact, they should be exempted from this law, and efforts are underway to make that exemption reality.)
2nd Annual American College of Private Physicians (ACPP) Meeting at The Vdara in Las Vegas, NV September 24th and 25th, 2016
The shortage of doctors will increase as more retire prematurely. As others take salaried jobs production and access will drop further since such employment arrangements always result in doctors behaving like employees rather than entrepreneurs, with a predictable loss of productivity.
There is a third option. Solo and small group doctors can do what we have done and form direct financial relationships with their patients in concierge practice and other forms of direct practice so the drastic cuts coming in the next few years will not affect them. Already the Affordable Care Act (Obamacare) has resulted in a massive increase in concierge and direct practice conversions, and that trend will accelerate.
Employees of large companies are now actively looking for concierge and direct practice access arranged by their employers, because in this brave new world since the passage of the ACA and now MACRA their deductibles and co-pays have soared so high that they might as well not have insurance at all. Furthermore, when they try to make an appointment with a physician there are higher and higher barriers to access delaying care, which essentially amounts to denied care. So, the emergency room has become the default location of care for millions. However, investing in membership in a concierge or direct practice once again gives them immediate and affordable access to care.
ACPP should be the organization that helps these new concierge and DP doctors improve and refine their practices, give them a voice in state and federal government, and provide them with a network of like minded physicians with whom to collaborate.
So, we hope to see all of you in September at our second annual ACPP meeting September 24-25 in Las Vegas. It will be a fabulous meeting with amazing speakers and networking opportunities. I hope to see you there.
Dr. Thomas Lagrelius of Skypark Preferred Family Care, a Direct-Pay Medical Practice
Skypark Preferred Family Care.
Thomas W. LaGrelius, MD, FAAFP
President, ACPP
The 2nd Annual American College of Private Physicians (ACPP) Meeting
Healthcare for Patients, Not Payors
September 24th and 25th
at the Vdara, Las Vegas, NV
LEARN MORE AND REGISTER, click here
Welcome to registration and information for the 2nd Annual American College of Private Physicians (ACPP) meeting which will be held at the Vdara in Las Vegas, Nevada on September 24th and 25th, 2016.
You may register online or print off the registration and fax or email it to the ACPP. We have prepared a very interesting and informative educational agenda for this meeting and look forward to seeing you in Las Vegas in September.
SEPTEMBER 24-25, 2016 LAS VEGAS REGISTRATION
Register by August 15, 2016 for Early Registration rates.
Online Registration
Click here to start the Online Registration Process.
Written registration
Please mail or fax the registration form to:
ACPP
2501 Cherry Avenue, Suite 265
Signal Hill, California, 90755
Fax: (562) 424-8680
Cancellation Policy
Cancellations will be granted until August 30,2016. All cancellations must be sent in writing to ACPP via mail, fax or email. A $300.00 charge will be subtracted from your refund to cover processing fees. No refunds will be issued for cancellations received after August 30,2016.
