If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

Guest Post From Barbara Duck, Proprietor of The Medical Quack Blog

imageFirst question out of the barrel might be “how can that be”.  It’s really not too difficult to figure out.  A short while back United Healthcare bought a pharmacy benefit manager named Catamaran, and actually took on $10 billion in debt to acquire them.  This has been in the news for a while actually, so how did you end up with United Healthcare.  It’s easy, Catamaran is the Pharmacy Benefit Manager for Cigna, so when United bought the company, it became a subsidiary of United Healthcare, so there you go.  The company is now a subsidiary of the huge too big to fail health insurer, who actually gets 2/3rds of their revenue from insurance policies and the rest from selling software and algorithms for a big chunk of the other third. Continue reading

How to return healthcare to real healing

“Osteopathic family physicians have always had patient centered medical home practices. We don’t need insurance or government bodies to certify us for money. We also shouldn’t be forced to sell patient and physician private data for money. we shouldn’t be forced to work for hospital systems due to complicated cronyism federal law. DPC Direct primary care changes 70 years of insurance and government lies and deceit back to the privileged individual patient-physician relationship.” Craig M. Wax DO

Back to Puke, Purge and Blister ?

Since 1888 when the first Osteopath put forth the Principles of Osteopathy and a comprehensive therapeutic program that was much more than puke, purge and blister which was the practice of “Medicine” at that time and as a result was run out of Kansas and went to Kirksville MO where he established the first College of Osteopathy and after 6 years began the American Osteopathic Association which is now in the process of ending the degree of DO and sending all graduates of DO colleges of Osteopathic Medicine to ACGME programs approved by the ABMS and they will certified by the ABMS boards and there will be no more Osteopaths.

I am astounded by the apathy of practicing DO;s and an apparent lack of concern. There are many who think that they should unite with the Allopaths especially in acquiring Board certification. I have been a DO

since 1961 and was a practicing “Internist followed by cardiology and then an MD fellowship in rheumatology completed in 1971. In this time I have been threatened by a malpractice suit 5 times and these were never litigated. I practice rheumatology full time and will do so until my demise. We practice the highest standards of healthcare provision and currently have students rotating from 3 DO schools and 2 MD schools. The
students are astounded by the way we practice as we practice Osteopathy that is far advanced from that which is currently taught at Osteopathic Colleges of Osteopathic medicine. They are seeing patients that revere our way of practice.

We are putting all we can muster in establishing The American Association of Osteopathic Physicians and plan on being Osteopaths in our organization. We have established American Boards of Osteopathic Specialties to provide certification in all specialties. We are interested in how many may join us.

Charles L. Clay DO

The Simple Solution

The simple solution is to have patients buy their own direct primary care from their own physician of choice, and have an inexpensive catastrophic plan to reimburse them for hospital and other major expenses. The employer-sponsored health care and government takeover of medicine called Obamacare, I called the unaffordable careless act, because it’s both unaffordable short and long-term, as well as, totally careless and slipshod and it’s writing and execution, served only to drive costs through the roof and accessibility down. When individuals shop for the care they want and entities compete on price, quality and value, everybody wins.

Best wishes for good health,

Craig M. Wax, DO
Family Physician
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS
Twitter @drcraigwax

DPC Bill Still Allows Government to Dictate Standards of Care

Dr. Chip Smutny writes:

As I read about the AAFP endorsement of S 1989 I see we still have people in our organizations thinking that we can still play the government game at least partially.

“To participate in the demonstration project, DPC practices would have to meet performance targets established by Medicare. Qualifying practices would be required to offer enhanced services, including preventive care, wellness counseling, primary care, care coordination, appointments seven days a week, secure email and phone consultations, and 24/7 telephone access to consultations. If they failed to meet the targets for two consecutive years, they would be excluded from the initiative.”

This is still allowing government to dictate standards of care that they cannot support with data or even case studies that have any real statistical power. Continue reading

What’s the ICD-10 Code for Struck a Duck?

A physician writes:
A long time patient came in.  He told me he was fishing, his pole started to twitch, he turned around quickly and tripped over a duck, injuring his hip!  Never before, in my 25 years of practice, has a patient presented to me w such a c/o.
CMS lists ICD-10 codes for struck by duck and bitten by duck but I can’t find a *&#! code for struck a duck!
icd-10-duck

 

ICD 10: anticipated and unanticipated consequences of government mandate

ICD 10: anticipated an unanticipated consequences of government mandate

Craig M. Wax DO

October 1, 2015 ICD 10 was mandated by the US federal government department of health and human services (HHS). Their stated goal was to improve data collection and research but the consequences, both anticipated and unanticipated, are becoming clear. 

Even before day one of implementation, it has been costly in time, money, and work that needed to be redone. Laboratories and other testing facilities call constantly for new codes in ICD 10 before they will do testing on patients, even though the codes are for billing, insurance, and government bureaucracy purposes only. Patients are being turned away from labs and radiology facilities. 

Patient history and examination time is now squandered due to electronic health records EHR and chasing new ICD 10 codes. Insurance companies have required “referrals” since about 2000. Originally, referrals meant when a doctor recommends another doctor or facility and gave them an RX script to use that service. Initially, referrals become a paperwork game where a form was filled out for insurance to recognize the service. The insurance companies even said that the referral wasn’t even a guarantee of payment, so what was it for? Since, it has become an electronic online process with an Internet company owned by insurance companies called Navinet. Now, our staffs have to enter all the referring information and diagnosis codes in order for the insurance process to even begin or the patient be scheduled for the test at all. Now with ICD 10, the systems are not recognizing the codes and not allowing these insurance mandated processes that waste our time to even carry to completion so a patient can get the study they need.

Due to all these exogenous process mandates, patient care suffers. Less patient physician contact time is possible in the exam rooms. Physicians, and their staff, are designated data gatherers for insurance and government whims. Time and money are wasted by all parties that are gathering the mandated data. The data will be aggregated by government and pirated, patients extorted, and data lost, with no party responsible except for the physicians who entered it. Patients get frustrated because care is denied due to insurance not reimbursing for procedures due to flawed, complicated processes mandated by the insurance industry. All individual patients’ and physicians’ privacy, security, and care is lost. 

This is yet another government, and their industrial cronies, scheme to command the data and make money for themselves, while patients go without care and physicians suffer the unanticipated consequences. The medical community and its physicians must stop abiding by all the nonsense and get back to patient care with direct primary care; putting the patient first and responsible for their care. 

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Host of Your Health Matters

Rowan Radio 89.7 WGLS FM

http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS

Twitter @drcraigwax