Obamacare cost us trillions to save us millions.

Think about the math; Obamacare cost trillions to save us millions . It has taken over our the healthcare system, insurance system, funneling money to the hospitals and special interests, and stolen everybody’s right to choose to buy or not buy and insurance product. It is the biggest tax increase, biggest taxpayer funded entitlement and biggest theft of out rights in the history of our country. Obamacare Medicaid is not actual care, but a phony entitlement to enslave a population to vote for Washington cartel into perpetuity. I’m no fan of either party and their centralized power and money. We must repeal ACA and change DC now!

Best wishes for good health,

Craig M. Wax, DO
Family Physician
National Physicians Council on Healthcare Policy member

Killer Algorithms at the Drug Store

Guest post by Barbara Duck, @MedicalQuack: http://ducknetweb.blogspot.com/

Cigna & United Healthcare Face Class Action Suits-PBM Over Charging Customers for Prescriptions, OptumRX Pharmacy Benefit Management Software-“Front Running” Consumers With Killer Algorithms at the Drug Store

Here we go again.  If you haven’t figured this out yet, when you buy a Cigna Health insurance policy you get a two for one with 2 insurers.  Cigna provides the insurance benefits and then it’s pharmacy benefit manager, PBM OptumRX (biggest revenue sector subsidiary of United Healthcare) that runs all their formulas via the computer and tells the pharmacist what to charge you.  (Video at the break below-watch it!)

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

Continue reading

Dear CNBC, Please do your research before you comment…

Dear CNBC, please be advised that before you criticize anything, you should do your research. The unaffordable careless act, known as ACA Obamacare, has changed the entire field of health insurance to few government approved and some Medicaid subsidy plans. More than half the exchange insurance co-ops started with taxpayer dollars are now bankrupt.  Most private insurers have left Obamacare exchanges leaving monopolies or even threaten to leave no insurers present to prevent citizens from being fined by the IRS for not buying nonexistent policies(see stats below). 

ACA Obamacare has trashed the whole industry and taken competition out of the equation, leaving only high prices and poor coverage. Let me know if you need anything further.

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Media host

National Physicians Council on Healthcare Policy member

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Original post:

Trump trips up as he trashes Obamacare

Dan Mangan, CNBC

http://www.cnbc.com/2016/10/25/trump-says-his-workers-having-tremendous-problems-with-obamacare.html

In 6 Charts, the Rising Costs of Obamacare Rates

No Mandatory MOC – A physician pushes for reform in Maryland

Received from Maryland physician Jef Fernley, DO:

I have just got off the phone with Mary Beth Carozza, my State Delegate. Following in the wake of legal actions against MOC in OK, MI, Florida, and others, I expressed to her that I wish to have her champion legislation ending compulsory MOC in Maryland. The bill I’d offer basically says, if you wish to participate in Maintenance of Certification efforts, you are welcome to, if you do NOT, no employer, payer, etc. can use your board certification status to hire, fire, pay, not pay, promote, demote, etc. you. It makes MOC voluntary.

If you love MOC, truly believe that it’s improved the quality of your patient care, made you a better doctor, and that it’s completely worth the time, effort, and $$ you’ve invested, and you care not one bit how your board has used that tremendous surge in their income, then I apologize for having bothered you with this, feel free to delete without reading further. Continue reading

Final MACRA rule still byzantine and unworkable, patients lose.

The final MACRA rule expands exemptions, flexibility, claims ModernHealthCare.com but it is still byzantine and unworkable. Patients lose.

The 2,398 page rule can be downloaded here: https://qpp.cms.gov/docs/CMS-5517-FC.pdf

We haven’t read the all 2,398 pages yet but here are a few initial notes:

  • The low-volume threshold is now < $30,000 in Part B billings OR < 100 Part B Patients.The proposed rule was < $10,000 AND < 100 Patients.
  • The infamous table from the proposed rule showing 87% of solo docs would face a negative adjustment under MIPS has been “bleached.” The sanitized table no longer lists solo physicians separately, and claims that only 10% of practices from 1 to 9 physicians will will face negative adjustment.  Click here for image combining both new table and old table. Supposedly, overall, 94.7% of eligible clinicians will get a positive or neutral adjustment with 5.3% receiving a negative adjustment.

Another trouble spot to look out for (Page 1513):

“One commenter supported the inclusion of ABMS board certification and participation in Maintenance of Certification (MOC) Programs on Physician Compare. Another commenter recommended MOC participation as a measure in future rulemaking as part of quality performance data publicly reported on Physician Compare … We appreciate the points, concerns, and suggestions raised by commenters and, if feasible and appropriate under the statute, we may possibly consider these issues in future rulemaking. ”

Some other low-lights:

Re Privacy:

“We disagree with commenters who maintained that the disclosure of PHI to ONC or an ONC-ACB (authorized certification body) could be inconsistent with reasonable privacy or other organizational policies or would otherwise be an unjustified invasion of privacy or any other interest. As noted, the disclosure of this information would be authorized by law on the basis that it is a disclosure to a health oversight agency (ONC) for the purpose of determining compliance with a federal program (the ONC Health IT Certification Program). In addition, we note that any further disclosure of PHI by an ONC-ACB or ONC would be limited to disclosures authorized by law, such as under the federal Privacy Act of 1974, or the Freedom of Information Act (FOIA), as applicable.” (page 67)

Data-Collection from all-payers:

“In addition, we are finalizing our approach of including all-payer data for the QCDR, qualified registry, and EHR submission mechanisms because we believe this approach provides a more complete picture of each MIPS eligible clinician’s scope of practice and provides more access to data about specialties and subspecialties not currently captured in PQRS” (page 468)

“We desire all-payer data for all submission mechanisms, to create a more comprehensive picture of the practice performance. Section 1848(q)(5)(H) of the Act authorizes the Secretary to include, for purposes of quality measurement and performance analysis, data submitted by MIPS eligible clinicians with respect to items and services furnished to individuals who are not Medicare beneficiaries. As discussed in section II.E.5.b. of this final rule with comment period, we are finalizing our proposal to require MIPS eligible clinicians to report allpayer data on quality measures where possible.” (pg1396)

CMS will be accepting comments for 60 days, however the online comment portal is not yet open as far as we can determine.  Stay tuned!