Do doctors expire in 10 years? Asks Dr. Chip

Choose Wisely is a CMS backed program used by government, insurance, hospitals and corporate medicine to selectively eliminate physicians who won’t do what they ask and more importantly eliminate physicians who insist on delivering individualized physician care designed to get patients healed or to control their disease as best as possible.

MOC is the method by which Choose wily has control over the situation by requiring in the contracts that physicians comply or be dropped. Voluntary participation is a lie.

That is the same line of effluent discharge that created the logic that denying payment does not deny the patient the choice to have a procedure. This breech of contract was allowed by the same stake holders to be scripted into both healthcare laws and insurance contracts constructed to allow insurers to get off scot free from any liability their financial decisions might have on medical outcomes and patient lives. This legislative lobbying, federal campaign finance law and concentration of wealth program dramatically increased the cost of healthcare delivery without a cent going to the patient and did so in such a way that physicians must still ultimately carry all the responsibility of a medico-legal failure to deliver potentially life saving treatments to the individual.

If no one thought there was money behind this then the brief look at  the shuffling of executives at the top of the MOC businesses, ABIM and the other major corporations directly and indirectly involved in benefiting from control of all this taxpayer and premium payer money is clearly a hint at the degree of fraud being perpetrated upon the public. All of this is targeted with physicians being the scape goat and the “least expensive direction to turn toward” in terms of votes and dollars to eliminate from the equation. The expense not considered is the financial and health expense to the public.

Do we have a case? We think it is obvious, but the public is still caught up in the rhetoric and is being fed disinformation making them unsure. Losing trust is a huge factor in the destabilization of the public at times of voting so that all the political parties can carve up the population in ways they would not have been able to.  Without confusion being deliberately disseminated by campaign promises that can’t be kept and piggy backing laws to the point that no one even in congress has time to read them much less put them to tests BEFORE enacting the laws, logic is repeatedly denied application. The single common thread to all this is Americans losing faith in their government, big business and healthcare. They are placed on the singular path of how do I protect myself no matter what happens to everyone and anyone else. That goal makes intelligent choices disappear as we move from a truly civilized way of life back toward triable rule and might makes right disguised as Fair Legislation that the people would never support if the laws were line item separated.

They…. government, insurance, hospitals and the testing companies including ABIM and FSMB whatever classification they place themselves in this week, must agree that we have a case or they wouldn’t have applied for a change in venue. Change of venue is nearly always a method of taking a case out of hostile territory into a more favorable one to the person or group requesting the change.

In adding insult to injury the “obama scorecard” or the ACA roll out diatribe is still being though of as a success for the Law. Talk about disinformation at it’s peak. All it is saying is that people are enrolling.

It needs to answer the following before it can even begin to access the costs and the quality of what it proposes over the next decade:

  • How many are actually receiving coverage?
  • How many are actually sending in money for their premiums?
  • How much of the “free healthcare” (a bizarre thing to call any payment system) being given out is covered by the income collected, not promised?
  • How many of the previously insured became uninsured as a result of this change in accessing healthcare coverage?
  • How many of the enrollees are actually people and or families or companies that were covered before the rollout began?

These questions only begin to scratch the surface and the law itself actually remains unchallenged. Only the right to tax people for it was challenged. Costs were not contained in this rollout and the expenses keep coming from the taxpayer and premium payers who remain unrepresented except by stakeholders who have alternative responsibilities beyond the payers in these decisions.

Examples of the outrageousness of the law follows. Why was the pharmacological world allowed to raise prices on all it’s drugs by (internally calculated) extrapolating their “estimated costs over the next 5 years” before the law went into effect? Did you know that drugs through that legally approved (ACA) process had their individual “actual wholesale costs” in October of 2013 rise anywhere from 100% to 5000% in some cases and that some of the most essential drugs like insulin and many antibiotics were in the higher end of that spectrum?

How is it that the cost of existing insurance programs that survived the initial roll out were granted the right to adjust their premiums from 30% to 300% over their original cost “in anticipation of what it will cost to deliver healthcare coverage in the next 5 years” and no oversight was asked for or granted in the process of determining this cost averaging phenomenon?

Next, How is it that we as a populace are permitting the executive branch the ability to change laws without the benefit of congressional review. That constitutions division of labor between the branches is specific and has been abused the the point that the world laughs at our current form of democratic hypocrisy. Look it up on the BBC (UK) and you’ll see what is meant by that!

Still not clear? OK. NPI is and was a CMS construct yes? It is actively being used by pharmacies to deny physicians the right to prescribe, period. It is not everywhere but the pattern is expanding. It is yet another CMS formerly HCFA (remember them?) construct that allows refusal to treat patients and/or to stick the physician with the bill.

Still not convinced? Boy are you guys hard fought to recruit to being vocal against ACA, MOC, MOL, and third party including government being permitted any entrance between physician and patient.

The last big shot across the bow in this discourse for now involves ICD-10 and meaningful use. They are not separate. EHR’s are based currently in ICD-9 coding. if you have one you might already be ware of this. Your 80,000 dollar elephant in the room is going to cost you plenty more with the rollout of ICD-10. you will need to expand your database handling capacity, re-train your people, re-train your self, become more of an IT in-house maintenance person than you already are or, scrip your program, sign up for a behemoth supplier and pay exorbitant monthly fees that may or may not improve your income, may or may not improve your error rate, may or may not improve deliver of quality care etc. ad absurdum. Remember the promise that you would get money back from your investment? In this transition you investment is in obsolete systems and can be denied altogether. Read the law!

The cost of implementing the ICD-10 now rapidly approaching the (ICD-11 deadline for rollout by the way which on average happens every 5-10  years according to history {past performance may not be an indicator of future performance})

“According to Complete Practice Resources, the United States has a complex healthcare system chock full of highly influential special interest groups who control decision-making. “It has made implementation difficult; the deadline has continually been extended.” To elaborate: In August 2008, the Department of Health and Human Services proposed that medical professionals use ICD-10 for reporting diagnoses and procedures on healthcare transactions in the US. “On January 15, 2009, the U.S. Department of Health and Human Services (HHS) published a final rule establishing ICD-10 as the new national coding standard” with an implementation date of October 1, 2013, saidHCIM. And then 2013 became 2014. And then, just when we thought ICD-10 had finally broken through the bureaucratic red tape and the extensions were over, 2014 became 2015.” (From: and confirmed in   accessed 5/5/2014)

ICD-11 is due out in 2017.

The International Classification of Diseases 11th Revision is due by 2017 (from: accessed 5/5/2014)

Did you ever hear of planned obsolescence? look at what they have baited and trapped physicians into and we have repeatedly succumbed just so that we could stay at work. Well their solution was to capture us completely or take us out.

The public needs to see this, hear this be brought to face the facts before they go to vote in November 2014.

Local elections are the ones that will have the biggest effect on all of this not the national ones. Why? Those national candidates were selected by their respective parties so that they can continue doing what they are doing. They admit publicly that their fist job is re-election, not serving the people. Local elections are where those parties are built. Local elections change the face of the big parties. Local elections are where the people have the best chances of being heard and where someone with little money may have a shot at getting elected on principles and not on finances.

This is no longer a party system at work. The parties are broken because the public has not done its job at the local level.

Now we can look back at Dr. Jane Orient’s article  on “repeal and replace” with a different eye toward how do we get at this difficult issue rather than just com pain and write about it.

It is always about what we do or do not do. Even Yoda Knew that! “DO or DO NOT, THERE IS NO TRY!”

Petitions are nice because they show a trend or tendency but they are not an action, they are a summary of words and opinions. The actions that will be understood come in the form of how people spend their money and in how people vote.

How you can have an impact on that is about how you can understand your local politicians and how you can influence them and the public in your village, town, county and state. It is just like healthcare in this respect, the facts and the actions that work come from the bottom up, not the top down.

Sincerely yours in service to our patients and our profession,
Charles J Smutny III,DO, FAAO


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