My Dad’s definition of “mixed emotions” was seeing your mother-in-law drive off a cliff in your new car. A new Quality Payment Program (QPP) for practitioners takes effect this January, and I have mixed emotions about it. The final rule written by the U.S. Department of Health & Human Services is more than 2,000 pages long and has all the clarity of the tax code. It’s also fair to say that despite the hope of creating a patient-centered system focused on quality of care, the Centers for Medicare & Medicaid Services (CMS) has turned physician’s quality reporting into the equivalent of a GED for dropouts that anyone can pass. Frankly, the quality reporting process measures almost nothing about whether physicians actually provide quality patient care. On the other hand, consider a doctor in my building who sees wound care patients in his office. He performed 15 cellular product applications on one patient’s foot ulcer before referring him to me. (I controlled his bacterial bioburden and got him offloaded, and he healed.) I have lost count of the number of patients I’ve seen who have received thousands of dollars of advanced therapeutics without being provided the basics. When we pay for volume of services, disconnected from outcome or appropriateness, we waste resources and we do not get optimal patient care. We needed a different system. What we got was the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). [READ MORE]