A Call for Physicians to Gather in Support of Dr. Carson and Plan to Save American Medicine

Guest Post by Kumar Yogesh, MD

Yesterday we attended Attended Gathering in Nashville and met Dr. Carson. What a great guy !!

I believe time is short and we the physicians need to come up with a short, to the point and precise plan the general public can understand and other fellow physicians can support.

This is what I propose

  1. Kill the CPT-based payment system and get the AMA dictatorship out of our lives. The board of each society in medicine such as ACS, ACP, ACC, ACCP, ACOS, etc should get together and come up with payment schedule that best fits their expertise.
  2. RVU can be used as base unit.For example, as a pulmonologist, I would be happy with setting 1 RVU for basic visit, 2 RVU for moderate visit, 3 RVU for a complex visit. For procedures, setting 2.5 RVU for bronchoscopy, 1.5 RVU for pulmonary functions, 0.5 RVU for chest xray, etc.Similarly, surgeons can assign “X” RVU for appendectomy, “Y” for cholecystectomy, and so on.Payment rate per RVU can be determined based on the level of training and experience of the physician. For example, a mid-level provider, a new physician with three years of training, a senior physician with five years of specialty training and 10 years of experience, all these groups can have different payment rates according to their expertise.
  3. RVU can be calculated at the time of service by a built in software program and payment rendered when patient leaves. I have discussed the possibility of this with a number of software engineer friends and this is doable. If this program is implemented, 10% of cost for billing/chasing insurance companies (which is becoming a very dirty and corrupt game) is gone for all clinics and entire healthcare system!! Savings of billions of dollars!!
  4. Let patients be the owners of their charts. Digital chart can be put on iPhone or any Smartphone, USB, or such device owned by patient. Such devices will be password protected and HIPPA compliant. This can be done virus free and HIPPA compliant according to the software engineers and consultants I have spoken with. This will save at least 10% of cost for the entire healthcare system. It seems that my nurses are making endless copies for other doctors or hospitals all the time or having to spend hours of time on the phone with either machines or nonmedical people who have no idea about patient care. This process not only consumes tremendous amount of human time and resources but it also severely distracts/strains very good nurses and doctors from their primary task which is “patient care “. This entire process will be unnecessary if we let patients own and carry their charts with them. All the information will be available instantly wherever the patient is. When doctor renders his services, he types his own note in his computer. At the end of the visit, physician can transfer his note to patient’s is digital chart device. This way, physician will always be in the possession of the original record. If the physician makes any additional notes later, it can be transferred to patient’s chart electronically. This will eliminate tremendous amount of absolute mental torture, worthless repeated paper work and redundancy that patients and medical staff have to deal with on a daily basis under current system. This will save A LOT of time, money, mundane paper work and best of all restore the sanity for the healthcare workers and doctors who are absolutely going insane by these tortuous process imposed upon us —all Wins for all sides. Again, savings of billions of dollars!! Much more simple and efficient system at a lower cost.
  5. Most of these savings worth billions of dollars should be passed to patients lowering out of pocket cost and premiums for all. Bottom-line for providers income will not be affected since overhead will come down significantly. In fact physician income may rise modestly since efficiency and morale of entire team will improve. Win-win for all.
  6. Kill CMS and its dictatorship. President can appoint an independent board that may consist of 6 to 7 reputable medical centers across the country and ask them to develop medical decision making and treatment protocols based on state of the art current evidence based guidelines. When a physician is evaluating patient, treating patient, performing a procedure on patient, ordering imaging or other studies, this physician has to follow one of the guidelines/protocol. Physician needs to do this in front of patient in real-time with the use of Internet and monitors. Once the medical decision and plan is made, physician can answer all questions of patient/family/guardian according to review of guidelines as discussed above. Final Orders are entered into patient’s digital chart.

This should be the end of the story of a patient visit. Once this happens, there should be no need for prior authorization, denial by any insurance or government agency, no need for waste of our nursing/staff spending endless time on phone or talking to machines. Simply put, we physicians should be done at this time as we have completed our service. Any problems that arise afterwards will be dealt by patient and insurance since these are the two entities that hold agreement with each other.

K.Yogesh, MD

HDP/HSA policies cancelled: Yet another #ACA #EpicFail

My personal family business HDP w HSA policy was canceled as a direct result of PPACA/Obamacare. It was replaced with a plan that was double the cost. So, if we do the math, $800 plus $800 equals $1600, that’s a 100% increase. Others have had similar experience. Our states Blue Cross affiliate used to sell over 140 different plans, but now due to the unaffordable careless act, now only sells a dozen or so. Perhaps, we can also discuss the fact that we tax payers, through this government fascist program, pay over $1 million per policy. #ACA #EpicFail

CMS Medicare PQRS is Fatally Flawed

The PQRS CMS Medicare program is fatally flawed. Any program that is run by third parties, insurance companies or big government cannot possibly take into account all the necessary variables and patient value systems that exist. Physicians are held to that gold standard, while the other parties are held to no standard at all.

Patients deserve a time-honored, unique, private relationship with their physician that values their individual value system and is unfettered by government, insurance and other third party entities.

Craig M. Wax DO

Forcing ICD10 on the American Healthcare System

“Forcing ICD 10 on American healthcare after forcing the unaffordable careless act and electronic health records, the government and insurance industry expects not to play claims accurately for quite some time.”

Craig M. Wax DO

MOC: This Abuse Has to End NOW

Dr. Ken Lee weighs in on KevinMD blog post “The Real Cost of MOC is Stunning” :

This profession is too used to abuse . It begins in pre-med, medical school and our training as “students” where our US labor rights are violated. Even college athletes have won a Federal case to get classified as employees of the colleges that were using them as “students”.

We have to influence our colleagues to stop swallowing each cup of poison they want us to drink. The costs of MOC for Int Med exceeds what I get paid from any contract I have with United, Aetna or Cigna, making the MOC a huge loss anyway you look at it. The summer months are supposed to be slow for medical care but I was seeing 23 patients a day with another 90 minutes of computer work at night to just do the documentation, MU, PQRS etc.

The only way I could do MOC is to not sleep or sacrifice my family time which my wife says will never happen again as she has seen hundreds of hours lost in the past due to the re-certification exams. I have lost entire weeks of my life for this certification scam.

The human cost of MOC is not fully exposed and must be. The hundreds of hours of our scarce free time is lost for trivial pursuit that we all know does NOT improve patient care ( 2 JAMA studies 2014 prove this ) . The psychological toll of fear , potential loss of income and actual loss of money on this coercion is glossed over, as if we were all CEOs making $4million a year at a non-profit hospital.

I never see written interviews of the families who suffer the absence of a parent who is hostage to recertification /MOC; what does it do to them? This abuse has to end now . People call us doctor which seems to elevate us but in reality we have become almost slaves. One of my long times friends finally got his BA degree and he runs a hospital physician system that employs 22 MD/DOs ; they have to answer to him . So much for the doctor title.

Ken Lee , Internal Medicine, private practice.

Poll: How Much Time, Money Do You Spend on MOC?

Via Medical Economics:

A new study has set out to quantify the time and cost many internists and internal medicine (IM) subspecialists will spend to meet the American Board of Internal Medicine (ABIM) maintenance of certification (MOC) requirements. Over the course of 10 years, a 35% increase in fees and 26% increase in hours spent was found.

The study also found when the dollar value of physician time is added to MOC fees, internists and IM subspecialists will spend $23,607.

ABIM President Richard Baron, MD, disputed the study’s assumption that continuing medical education (CME) credits will only amount to 25% of the requirements. Baron said that CME could easily satisfy 100%, not 25%, of the requirements.

Medical Economics asks: Do these numbers accurately reflect an increase in the time and money you expect to spend on MOC over the next 10 years?

Give YOUR feedback in short poll at: http://www.medscape.com/viewarticle/849196

Patient’s bill of rights

by Carlisle Holland DO
1. I have the right to decide what happens to my body
2. I have the right to decide who I trust for my medical advice and treatment.
3. I have the right to decide what medications I take
4. I have the right to decide what medical treatments are done for my condition
5. I have a right to privacy of my medical information with my physician.