“There is no problem in American health care that government has not made worse,” contends healthcare policy expert Linda Gorman in an opinion piece published in The Hill on Wednesday. But she saw a glimpse of hope last week when the Medicare Payment Advisory Commission voted to recommend scrapping the Merit-Based Incentive Payment System because it “cannot succeed.”
As director of the Health Care Policy Center, which is free market think tank in Denver, Gorman points out that “ObamaCare rules have been more about wishful thinking, power, and cronyism than patient welfare or any realistic commitment to policies known to improve health care cost and quality.”
In fact, it sounds like a giant scam.
Gorman points to one example of how ObamaCare cronyism increases costs: The “Maintenance of Certification Program” (MOC), which she describes as “a continuous assessment program, such as qualified American Board of Medical Specialties (ABMS) Maintenance of Certification program or an equivalent program (as determined by the Secretary).”
“Physicians who participated in the ABMS MOC program became eligible for an additional Medicare incentive payment equal to 0.05 percent of their total estimated Medicare Part B Physician Fee Schedule reimbursements. The Medicare incentive payment morphed into the Merit-Based Incentive Program. It still bases payments on participation in ABMS MOC programs,” she epxlained, noting that when ObamaCare passed, ABMS had a virtual monopoly.
According to Gorman:
The Affordable Care Act used the standard tactic of creating market power by listing specific requirements that only the ABMS program could meet. Among other things, “equivalent programs” would have to report patient data to a registry, require periodic exams, and conducting periodic “practice assessments.”
The ABMS acts as an umbrella organization for a foundation and 24 Specialty Boards. Those Specialty Boards have historically given examinations to licensed physicians who have completed residency training in an accredited specialty program. Physicians passing those exams received a lifetime designation as “Board Certified” diplomates of one of the Specialty Boards. In 1990, the ABMS began requiring reexamination every 10 years. Its successful push to have its process inserted into the ObamaCare statute turned one time Board credentialing into a continuous process of tests, reporting, and “practice improvement modules.” Doctors paid test fees that created a revenue stream worth an estimated $1 billion in 2014.
The program is steeped in cronyism and has “become so burdensome for qualified physicians that states are considering legislation to protect physicians from losing their job if they fail to do ABMS bidding,” Gorman noted, adding that the program itself can’t credibly evaluate physicians for “quality”.
In fact, all it does is “raise costs, divert physician time from treating patients, and make running nonprofit quality metric and testing programs more lucrative than treating patients.”
A select group doctors, including Dr. Christine Cassel, director of the non-profit American Board of Internal Medicine, have profited greatly from the program.
According to Gorman, “In 2011, when the average specialist in pediatrics made around $150,000 a year, the top board member of the American Board of Pediatrics received over $900,000 in compensation. When Board Certified internists made just under $200,000 a year, compensation for Dr. Christine Cassel, the head of the non-profit American Board of Internal Medicine, was almost $790,000.”
She further points out:
In 2013, Dr. Cassel became president and CEO of the National Quality Forum, a nominally non-profit group that produces measures used in federal “public reporting and pay-for-performance programs.“ At the same time, she received $235,000 as a board member for Premier, a North Carolina company with $249 million in revenues from selling supply chain services, data, quality metrics, and efficiency improvement strategies. From 2010 to 2012 she received over $500,000 for serving on the Board of the Kaiser Foundation Health Plans and Hospitals. Kaiser operates Medicare Advantage plans. It benefits if Medicare adopts its quality measures.
After a 2014 article in Pro Publica pointed out the obvious conflicts of interest, Dr. Cassel left the Kaiser and Premier Boards. She was appointed Planning Dean of Kaiser’s new medical school in 2015.
According to Gorman, “If Congress is interested in lowering health care costs for everyone, following the Medicare Payment Advisory Commission’s recommendation to scrap the Merit-Based Incentive Payment System and its payments for ABMS Maintenance of Certification is a good place to start.” But it sounds like this is just the tip of the iceberg.