Govt to Doctors on Compliance: Damned if you do and if you don’t.

(HITECH/MU/EHR, HIPAA, PPACA, etc.)

Last Decade, US Government decided, under strong lobbies by IT sector, health insurance, massive hospital systems and big business, to force Electronic Health Records on ALL physicians. The promise was, “Begin participating in 2011 and 2012 to earn the maximum incentive – up to $44,000 for Medicare and up to $63,750 for Medicaid!” & “Certified EHR technology can help improve the quality of health outcomes and the efficiency of healthcare, while providing privacy and security safe guards.”

The reality is that physicians and healthcare facilities paid up to $70,000 per physician per year to establish and maintain EHR(healthHIT.gov, NEJM, JAMA). Physicians had to deal with constant work disruption, steep learning curves, temporary and permanent loss of productivity costing even more money. Millions of EHR records are lost, stolen & pirated yearly from many sources. HHS demends that physicians had to meet the criteria for Meaningful use (MU) stages I-III to get the promissory reimbursment. The HRSA.gov & healthit.gov websites state that if you have not met MU criteria by 2015, “…you will be subject to a reduction on all Medicare claims.” In reality, the government is asserting that EHR is not really optional, but mandatory, via the “carrot and stick,” threat. Consequently HITECH EHR MU audits have now begun to assess compliance and recover government investment.
The government promised that PPACA Obamacare would provide all citizens with “free health insurance.” in 2013, we saw efficient discount health insurance plans, like Horizon NJ basic and essential plan, dropped from the market, while insurers scrambled to meet the government edict with bloated plans that cost up to 200% more. The reality is that the government can only penalize those that don’t buy inflated cost health insurance that meets their arbitrary guidelines, not actually provide health insurance, and certainly not provide the actual care; physicians do that.

The fed had three years to develop an infrastructure for the PPACA Obamacare website registration system for the mandatory health insurance all taxpaying citizens must buy or they will be fined(er, taxed). They outsourced the HIT work (read that “jobs,”) to Canada. We all watched in disbelief as Obamacare rolled out with a bang in October and no one could sign up due to errors and non-existent customer support. This is typical of most government programs in general and all entitlement programs; radical idea, poor planning, massive budget overruns ($90 million became $680 million and the website still wasn’t functional), and dreadful execution.

Our time honored medical tradition is to respect a patient’s privacy. Traditionally we could lose our professional reputations in our community or be sued if our patient’s privacy was violated. Now with HIPAA, the government can audit us without notice and play the roles of judge, jury and executioner. In fact, the government is quite proud of their Recovery Audit Program (RAC) reclaiming over $200 billion in so-called fraudulent claims in 2012. Physicians must hire their own attorney, deal with practice disruption and lost patient visit income, and defend themselves against a government sponsored bounty hunters with seemingly unlimited time and money.

Physicians are damned if we do and damned if we don’t comply with expensive, arbitrary and patient-physician privacy conflicted government edicts. It seems best to assert our right to practice medicine in the way we see fit for the betterment of our patient care in any way that best suits our individual patients. This can only be accomplished by opting out of ALL insurance and government programs, thereby opting out both ourselves and patients from those impediments to care. Patients pay physicians and facilities directly at competitive prices on the freemarket; quality and service up while prices go down. Everyone wins!

Best wishes for good health,
Craig M. Wax, DO

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One thought on “Govt to Doctors on Compliance: Damned if you do and if you don’t.

  1. Dr. Wax is right on the mark, as usual. My further comments:

    1) The concepts of “insurance” and the underwriting of actuarial risks do not apply to healthcare coverage under the Affordable Care Act (ACA).
    The closest accurate example of true healthcare insurance would be catastrophic coverage with a deductible of at least $10,000 per individual.
    This allows the insurer to apply actuarial mathematics accurately to underwrite policies to cover rare events, like massive trauma or life-threatening diseases.
    A true insurer has no business arguing with your doctor about whether or not your policy should pay for a minor or routine diagnostic test or treatment.
    Catastrophic policies thereby eliminate a huge bureaucratic expense for insurers, who only expect a claim maybe once a decade from an individual.
    I understand that catastrophic policies will be illegal under the ACA.
    And, of course, they are out of the question for those who cannot pay a high deductible.

    2) What the populace wants is a heavily subsidized government benefit program, like Medicare, for everyone.
    This will be very expensive, and might price us out of waging pointless perpetual ground wars in Asia, which President Johnson warned us against in 1963.
    Just before he engaged in one !

    3) Obamacare is doomed because they left out tort reform.
    The malpractice crisis is improving because of states like Texas and California, which have instituted weak tort reform. More is needed.
    We must come to understand that malpractice cases can only be decided by “a jury of our peers”.
    That means doctors with the same specialty training as the defendant physician.
    Anything less will continue to make rational medical decision-making impossible.
    Loser-pays will also help, plus a cap on non-economic damages.
    Why was tort reform neglected?
    Sebelius worked as a lobbyist for the trial lawyers for 9 years.

    4) Insurance actuaries, claims executives, and marketers have spent a lifetime learning their specialized skills.
    Obamacare’s 2800 pages of regulations were written by ideologists who never insured anyone.
    You cannot throw out a huge complex system which has evolved over decades and serves most people fairly well, and replace it instantly with a utopian plan concocted by bureaucrats.
    This approach was tried before. The theory was that forced collectivization of farmers would increase crop yields. Tens of millions starved as a result.
    We are now seeing that the incompetents who devised ObamaCare cannot even administer a website to enroll people.
    Enrolling people is the easy part !
    Can you imagine how disastrous they will be at actually administering the payments for health care ??

    David L. Keller, M.D.
    Redondo Beach, CA

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