The Scarlet Zero: MACRA completes the government takeover of medicine.

• Author: Held, Kristin
• Position: Medicare Access and CHIP Reauthorization Act of 2015

When Medicare and Medicaid were created, the government promised not to interfere in the practice of medicine. Pres. Lyndon Johnson signed the act into law on July 30, 1965, ironically in Independence, Mo.

It read: "Nothing in this title 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... or to exercise any supervision or control over the administration or operation of any such [health-care] institution, agency, or person."

Fifty years later, in flagrant violation of this prohibition clause, stands the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), replete with the Merit-Based Incentive Payment System. MIPS is a rubric the Federal government uses to grade physicians and assign each a score of zero to 100. The Composite Performance Score is used to incentivize or penalize physicians financially, and then the scores are posted on a public website for all to see.

The core of MIPS is the ultimate conflict of interest: the very lives and well-being of patients versus the money and power of the medico-industrial complex run by a small group of insider elites, implemented and micromanaged by entrenched, faceless deep-state bureaucrats. Physicians must choose sides.

Will your physician follow the tradition of Hippocrates, who believed the physician works on behalf of the patient, not for the good of the state--risking his or her livelihood, or will he or she follow the Greek philosopher Plato, who urged that doctors refrain from curing the weak and infirm to improve society? MIPS incentives mean punishment and abuse for serving patients first, and rewards for serving society.

MIPS grades physicians on quality (outcomes), advancing care information, improvement activities, and cost. Earning a high score often requires doing what government says instead of what is best for the patient.

"Quality indicators" and "outcome measures" may sound great, but they may deter physicians from taking on the most-difficult and challenging patients. For example, one measure of outcome is how many of a physician's patients achieve a Wood glucose level under a certain number. One of my patients told me she has passed out twice, sustaining injuries, since her physician assistant...