A Brief Historical Summary Outlining How The Practice Of Medicine Has Been Regulated

1929 First Employer sponsored health insurance created for teachers- later gave rise to Blue Cross

1946 The McCarran-Ferguson Act was passed that exempts the business of insurance from most federal regulations including anti-trust laws in some instances.

1965 CMS created- Center for Medicare and Medicaid – the United States Taxpayer sponsored healthcare coverage for the elderly disabled and the poor created from the amendments to the Social Security Act of 1935. 1

1971-1972 More social security’s acts amendments widened enrolment in CMS

1973 HMO’s Health Maintenance Organization act of 1973- incentivized the privatization of insurance

1981 ACGME created to fund advanced medical education – created because VA hospitals could not staff –created a way to get cheap labor from highly trained physicians.

1982 EFRA Equity and Fiscal Responsibility Act of 1982 - created more government incentives to utilize the for-profit HMO’s

1986 EMTALA Emergency Medical Treatment and Labor Act -requires every patient to be screened for an emergency regardless of ability or willingness to pay.

1991 OIG HSS safe harbor law that protects PBM’s and GPO’s from anti-kickback laws 2 &18

1992 Current Procedural Terminologies (CPT’S) Diagnostic Related Groups (DRG’s) and Relative Value Units (RVU’s) and International Classification of Diseases (ICD’s) all created in an attempt to control costs by monitoring and controlling how physicians spend healthcare dollars – all controlled by the AMA (American Medical Association) 3

1996 HIPAA was created - The Health Insurance Portability and Accountability Act of 1996 which created standards for the electronic exchange, privacy and security of health information. Final privacy rule published in 2000

1997 SGR- sustainable growth rate created. A freeze on graduate medical education was created which has contributed to the current physician shortage

2003 changes made to HIPAA eliminated patients' right to control the disclosure of their own medical records.

2009 The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 to attempt to address the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules

2010 ACA “Affordable Care Act” incentivized everyone to have insurance coverage by penalizing those that do not.

2014/2015 MACRA The Medicare Access and CHIP Reauthorization Act of 2015

2016 PQRS- Physician Quality Reporting System – ended 2016 and became MIPS

2017 MIPS Merit Based Incentives Payment System- attempts to tie payments to “outcomes” and replaces PQRS – a “patchwork collection of programs” according to CMS

Despite efforts by the government to regulate and control the healthcare system it continues to get more expensive and less efficient. Considering our laborious legislative process, the likelihood for major change within our current system is low. Special interests who have a lot to lose, spend money on lobbying to keep their interests in favor. Furthermore, many of the above policies took years to create, and with the acceleration and advancements we are making in technology it is becoming impossible to create policies in a timely enough fashion in order to keep up.

So how do we fix this? The answer lies in putting those with the appropriate competency, training and compassion back in charge: the physicians! 

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