Multiple Chronic Conditions Blog

Centers for Medicare and Medicaid Open Comments on MACRA

Sunday, 15 May 2016 13:44 / by Dr Kim Kuebler

I continue to read and review multiple comments made by providers who are pushing back on the upcoming MACRA changes - unfortunately, all of this is bigger and moving faster than any health care tsunami in US history. We have too! We can no longer afford to deliver suboptimal care at excessive costs. Our society is becoming unhealthier by the minute and we cannot allow a system to support illness and disease - we have to turn things around - we all have to become accountable stewards in the care, cost and delivery of safe and effective care. What a shame that the IOM Report from 2000, 2009 and recent JAMA paper reminds us of how poorly our country is providing safe, effective, evidence based health care. The US ranks in the mid 30's worldwide for best care and we score on the same level as Pakistan. Medicine is changing, health care is changing and all of these new changes should bring opportunity. Data drives change and we have to begin somewhere. I am fearful about physicians taking earlier retirement and opting out of primary care - that leaves even more problems in the safe delivery of best health care practices. My data suggests that nurse practitioners are not prepared to clinically meet or address the care needs of the largest, fastest growing and costliest US patient population - those with multiple chronic conditions.

We cannot afford to complain and push back on the momentum and eventual changes that we will all be accountable for - like all new systems - there is a trial and error period. We cannot realistically continue to practice as we have - with the focus on "doing it the way it has always been done" - it isn't working and it is not providing the best care to those in need.

We need to be reminded of what we look like as a country of medical inconsistencies - ask around - check with your colleagues - how many are implementing and utilizing the most current evidence based practice guidelines from the Agency for Healthcare Research and Quality? How many are no longer prescribing Cipro from the FDA's warning that risk outweigh benefit - how many are no longer prescribing prophylactic aspirin in patients older than 60 who have not had an MI - how many have embraced the JNC-8 guidelines in the management of hypertension and not prescribing Ace Inhibitors for African American patients?

Demonstrating quality measures, may be difficult at first - but as a health care provider - I know that if I am following and implementing the best evidence in my practice - my value and quality scores should and will reflect my safe care. I welcome transparency and believe that this will become an opportunity to determine which provider is not implementing evidence from those that are.

Financial incentives have driven US health care - not quality, not evidence and certainly not considering the important needs of our society - we must move away from disease and place more importance and efforts on prevention. We have to focus on the massive epidemic of obesity and allow our culture to accept these escalating trends. This is no longer about staying comfortable and keeping things the way they "used to be". This is about changing a culture of health for patient and provider. This is about looking at the bigger picture and knowing that we cannot possibly sustain ourselves at the rate things are going.

Bigger issues should focus on long-term care, meeting the disparities of the elderly population, ensuring safe housing, food, and transportation. This is going to take collaboration, hard work and an ability to roll up our sleeves and work to ensure a better health care system for all - not a health care system for the provider - a health care system that is sustainable and evolves based upon the greater needs of our country.

Dr Kim Kuebler

Dr Kim Kuebler

Dr. Kim Kuebler DNP, APRN, ANP-BC, Founder and Director Multiple Chronic Conditions Resource Center, CEO Advanced Disease Concepts, LLC., Award winning author of 8 textbooks on chronic conditions and palliative care. Multiple appointments to Federal and state initiatives on pain, chronic conditions and palliative care. Clinician, educator, researcher and patient advocate.