“Act II began in 1972 with “landmark” Professional Standards Review Organizations (PSRO) and more utilization review regulations, soon followed by Medicare fee caps and then the Resource-Based Relative Value Scale (RB-RVS).
“Act III was the bold Clinton initiative to expand federal control into all of American medicine, using the managed-care mechanism that had gotten a federal boost with the HMO Act of 1973. While the Clinton Health Security Act itself did not pass, the backup strategy worked: the State Children’s Health Insurance Program (SCHIP) plus the incorporation of essential elements of the Clinton Plan into the Health Insurance Portability and Accountability Act (HIPAA). These included vast expansion of the funding and powers of federal law enforcement, draconian civil monetary penalties, and harsh prison sentences for “healthcare” crimes that previously might have been called billing errors. In the guise of “privacy,” the foundation was laid for forcing adoption of electronic health records (EHRs), a necessary surveillance tool.”
“Act IV, the Affordable Care Act (ACA), herded almost everyone into federally regulated third-party payment schemes. The costly bureaucracy drove increased hospital consolidation, impelling independent physicians to join Big Healthcare systems. Largely thanks to ACA, the HHS paperwork burden has increased to 700 million hr/yr, up by 300 million since Obama took office. It takes 354,500 full-time private-sector employees to comply. There are 86 new ACA rules pending, one with an estimated cost of $41.8 billion.”
“Now comes Act V, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), with 962 pages of newly released regulations. This could be the coup de grâce. “
“The new physician payment rule would be “financial suicide” for small practices, said Farzad Mostashari, who spent 2 years leading the White House effort to implement EHRs. “
The rules make the federal government and its proxies the arbiters of “quality” and “value,” and require physicians to allow CMS to access all medical records of all patients. A new class of intermediaries must keep the data for CMS audit for 10 years minimum, if not a lifetime in targeted cases, writes AAPS director Kristin Held, M.D., in a meticulous analysis of the rules.”