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A Target for Repeal in Obamacare: Pay for Performance. Obamacare on the Frontlines.

Hospitals are being denied payment if they don’t meet federal “Quality guidelines”.  Trouble is, these guidelines actually do NOTHING to improve patient outcomes (like death rates). Conmpliance with these guidelines also actually harm people by causing the wrong care that may lead to death, more suffering or diversion of resources from other needed care.  Soon doctors will be mandated to follow the government’s so called “quality and efficiency guidelines” or they will be penalized and be put out of business. It is in this way that your doctor becomes and agent for the state – a cog in the system working for everyone EXCEPT the patient. It is time to repeal the unethical Obamacare program called “Value Based Purchasing” (also known as “Pay for Performance”). This piece was published a few days after Obamacare Passed Congress.

An Early Target in Obamacare
By David McKalip, M.D.
View all 22 articles by David McKalip, M.D.
Published 03/23/10

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Pay for Performance: An Early Target for Revolutionary Repeal of Obamacare

As the elitists in our nation’s capital celebrate an unprecedented take over of health care by government and corporations, it is imperative that we begin the work of repealing the many provisions of this bill that hurt patients. While the individual mandate is a necessary and important target for attack, there is an even more sinister component of Obamacare that must be repealed by a new Congress: “Pay for Performance”. This will be one of the key victories liberty lovers should work for in the new “peaceful revolution” of America in 2010.

Pay for Performance (PFP) is a system that provides “incentive” payments for physicians and hospitals to comply with cost-cutting goals of government and insurance companies. Rather than being a reward for providing the best care for patients, PFP is better described as a system that punishes doctors for spending health care dollars on their patients. PFP thus really stands for “Penalties for Physicians” or “Punish for Practice”. The doctor will have a choice: do the right thing and offer the most innovative and appropriate care to patients, or fail to even tell the patient about all the more costly care that is available to them. It will be difficult to trust your doctor in this new system.

Pay for performance has been shown to lead doctors to avoid sick patients and game the system for good report cards. It requires expensive and cumbersome computerized medical record systems that distract doctors and nurses from patient care and drains money from patients as well. Following government medical protocols has been shown to hurt patients who automatically receive so called “best practices” with no thought given to the individual patient. And for all this, it has been conclusively shown that PFP does not decrease death rates or suffering. The only way it can hope to reduce costs is through forced rationing by punishing physicians for going over budget on patient care.

Like so many other areas of this bill, the Secretary of Health and Human Services (HHS) will be given broad powers to dictate what is considered an appropriate amount of spending. Doctors are about to be placed on a budget for each episode of care. Doctors will be paid less if the cost of care of patient care is higher than budgeted. Section 3007 of HR 3590 states these costs are “expenditures per individual as determined appropriate by the Secretary” and the “Secretary may take into account the amount of growth in expenditures per individual for a physician compared to the amount of such growth for other physicians”. Thus, if your doctors is getting out of line and spending more than other docs, they will be singled out for punishment. That is a powerful incentive to change the culture of medicine from one of serving individual patients to one of going along with the group to serve the bureaucrats. These cost measures and the determination of whether a doctor was unfairly penalized can’t be appealed to any court (“There shall be no administrative or judicial review (page 676)). Herein congress again shows its contempt for the US constitution, American citizens, doctors and patients. Access to the courts and due process is a fundamental right for Americans. It will be important for a test case to be found to challenge this denial of rights to the courts. Another battle for the peaceful revolution.

The Secretary will also have broad powers as well to define what a “quality physician” is and bribe patients to see who she says. Section 10331 empowers her to pay Medicare patients an “incentive” to see the doctor that a bureaucrat approves. The secretary will arbitrarily designate a “quality physician” based in large part on cost considerations including “resource use” and “efficiency” and “other information as determined appropriate by the Secretary”. Herein we see a glaring example of creating monarchal powers for the Secretary of HHS.

One of the biggest miracles of the founding America was that individuals could escape living under the arbitrary rule of man. We were founded as a nation where the “rule of law” prevailed so that no monarch or man could force us to live in fear and bend our lives to their wills. That will not be the case with Obamacare’s Pay for Performance models. Committees will create protocols with one goal in mind: cut spending on patient care. Doctors who choose to follow their ethical obligation to offer a patient all appropriate care will be singled out and punished. They will be placed in the newspaper with a bad rating and economically penalized until they can no longer remain in medical practice.

In my March 16, 2010 Piece on Campaign for Liberty, I indicated that Congress is showing contempt for America by forcing this bill to pass and was planting the seeds of a peaceful second American Revolution. One of the goals we should fight for in this revolution is electing enough principled Congressman in November 2010 to repeal all Pay for Performance language in America’s unjust health laws in 2011. President Obama will then need to explain why he would veto a bill that would prevent rationing by insurance companies and the government. Call for the Republican party leaders to immediately call for repeal of pay for performance and all its variants in the law. The time has come to recruit more soldiers and work for victory. I will see you on the battlefield for freedom.

Copyright © 2010 Campaign for Liberty

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