ALERT: Opportunity to Help ALL patients access Direct Care with latest Coronavirus aid bill

Update 3/22/2020: It appears that the flawed language has been removed from consideration! Now it is time to ask the Senate to ADD good language from S. 3112, the Personalized Care Act.

Please contact your Senators ASAP with the following request: Please include S. 3112, the Personalized Care Act in the upcoming bill to address the Coronavirus epidemic. Allow all patients to use Health Savings Accounts for direct care arrangements with their trusted doctors, without unnecessary red tape and limits on patients’ options.

Phone numbers for all Senators and the email addresses of their healthcare legislative staff can be found at: bit.ly/senfull2020

Empowering patients to access low cost, high quality medical care, from independent physicians is more urgent than ever!


Tell Congress to Remove Flawed Direct Primary Care Language from Emergency Legislation

Dear AAPS Members and Friends,

Earlier this week we alerted you to provisions in the House coronavirus relief bill that are harmful to small medical practices and all small businesses.  The bill was made slightly less bad before it ultimately passed and was signed by the President.

You can read more about the changes and impact for small businesses here:

https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/senate-to-vote-soon-on-coronavirus-paid-leave-mandate.aspx

Now the Senate is working on a third bill related to the ongoing situation with COVID-19. 

A 247-page draft of the bill is now online here:
https://www.republicanleader.senate.gov/imo/media/doc/CARES%20Act%20Final%20-%20Mar%202020.pdf

It has a number of health policy related items tucked into it, for instance a temporary suspension of Medicare sequestration payment reductions.  It also has provisions easing FDA regulations that may impede timely care, and requires that “each provider of a diagnostic test for COVID-19 shall make public the cash price for such test on a public internet website of such provider.”

One immediate concern about the latest bill is that it contains flawed language (Sec. 4403) intended to fix the incompatibility of Health Savings Accounts and Direct Primary Care caused by current IRS law and policy.

A solution for this problem is needed, but the Senate language mirrors problematic policies from past versions of related legislation.

For instance:

1. The bill caps patients’ “aggregate” direct primary care fees at $150/month. Most DPC fees are well under that amount but imposing price controls on care paid for from HSAs would be a dangerous precedent.  And the cap also limits the flexibility of physicians and patients to tailor agreements based on individual patient needs. 

2. The bill limits DPC agreements to “primary care practitioners as defined in section 1833(x)(2)(A) of the Social Security Act.” It also imposes other limits on the types of care that can be included in agreements. These limitations are unwise and also improperly limits the options of patients and physicians.

3. The bill adds DPC to the the section of IRS code that lists types of insurance eligible for payment from HSAs. Labeling DPC as a type of insurance, or type of coverage, is not the right way to correct the flaws in the IRS code and increases the risk of overregulation of innovative DPC practices.

Here’s what you can do:

1) Ask your Senators to remove Section 4403:

Please call your Senators ASAP and ask them to“Remove Sec. 4403 from the 3rd coronavirus bill and replace it with S. 3112, the Personalized Care Act.  Sec. 4403 overregulates innovative direct care arrangements that are increasing patient access to low cost, high quality medical care. This flawed language will do more harm than good. Congress instead should enact S. 3112 and allow all patients to use Health Savings Accounts for direct care arrangements without unnecessary limits on patients’ options.”  

You can find your Senators’ phone numbers at: 
https://www.senate.gov/general/contact_information/senators_cfm.cfm

Alternatively, you may phone the United States Capitol switchboard at (202) 224-3121. A switchboard operator will connect you directly with the Senate office you request.

2) Next call your House members and tell them the same thing!

Contact info at https://www.house.gov/representatives or Capitol switchboard at (202) 224-3121

3) Finally call President Trump to warn him about this bad provision and ask him to demand Congress remove it:

White House Phone #:  (202) 456-1111.

White House Contact Form: https://www.whitehouse.gov/contact/

Please share this alert and encourage others to call. Thank you!

Independent physicians plan to battle #coronavirus #COVID19, tackle Homeland security and ensure patient freedom and choice

By Craig M. Wax DO

CORONA VIRUS COVID19 – INDEPENDENT & EMPLOYED PHYSICIANS NEED:

Click here for printable PDF you can send to your Members of Congress.

Independent testing sites and protocols with universal precautions

Guidelines for Medicare and insurance companies to pay for telemedicine (Audio and Video) to screen patients from their homes (Full fee schedule)

1. Temporary regs x 6 months and return to in-person standard of care

  • Eliminate insurance red tape: prior authorizations (Rx) and precertification (procedures)
  • Eliminate insurance networks to allow all physician to aid all patients
  • Support for independent physician practices to remain viable
  • Running a highly regulated business with employed staff in an epidemic
  • Regulatory, legal, contractual, taxes, overhead, need to pay staff despite changing model from in person medicine to audio and video telemedicine
  • Safety for physicians and staff to continue to provide medical care
  • Issue all physicians all protective gear if they are to see patients in their offices
  • Physician direct Rx dispense (only legal in certain states, not NJ, NY,MA, TX…)
  • Eliminating mandatory eRX as it limits physician and patient options.
  • Suspend federal law to allow Medicaid non-par physician to Rx and order tests
  • Suspend MACRA MIPS and all “quality measures”
  • Suspend or eliminate MOC (maintenance of certification) and OCC (Osteopathic Certification) mandates imposed by hospital and insurance companies (currently blocks patient access)
  • Any available physician who completed MD and DO school and two steps of USMLE or NBOME should be eligible to practice.  There’s a population of trained physicians who can’t secure a residency slot due to inadequate number of US slots (Missouri state model). They have more training and experience than NPs and PAs.

HOMELAND SECURITY AND CORONAVIRUS COVID 19

  1. Chinese Government Endangered the World1
  2. COVID 19 cases began November but covered up through end of December
  3. China Rx – China is contractor and subcontractor for most pharmaceuticals,2,3,4

World pharmaceutical, protective equipment and technology supply chain compromised.

             D.  Critical Rx and Supply Shortages 2

              F.  COVID19 potential treatments:  Chloroquine and hydrocycholoquine (Plaquenil)5

                        1. generic and inexpensive

                        2. not FDA approved for COVID19 virus treatment

                        3. no complete controlled studies, beginning use abroad and domestic

                        4. Dosage and indications unclear to get benefit and avoid toxicity

CORONA VIRUS – COVID 19

1https://foreignpolicy.com/2020/02/15/coronavirus-xi-jinping-chinas-incompetence-endangered-the-world/
2,https://thehill.com/policy/healthcare/484276-coronavirus-outbreak-could-cause-shortages-of-150-drugs-report

3China Rx, Gibson, Rosemary

5 https://www.moaa.org/Content/Publications-and-Media/News-Articles/2019-News-Articles/Made-in-China–How-U-S–Dependence-on-Chinese-Medicines-and-Components-Could-Pose-a-Security-Threat

5https://wattsupwiththat.com/2020/03/17/an-effective-treatment-for-coronavirus-covid-19-has-been-found-in-a-common-anti-malarial-drug/

How to Increase Access to Medical Care and Lower the Cost

Through Competition and Choice

A.   Unleash the Power of the Free Market in the Healthcare Sector

  • Expand patients’ freedom and choice in the use of health savings account dollars, especially as payment for direct primary care and other models of coverage, such as periodic-fee, membership subscription services.[1] [2]
  • Codify the use of Association Health Plans (AHPs) and Short-Term Limited Duration Insurance (STLDI) as affordable, portable alternatives to current models of coverage.[3]
  • Allow Medicaid patients to use provided monies as a voucher to purchase periodic fee services.
  • Repeal the “Safe Harbor” protections of 42 U.S.C. 1320a-7b(b)(3)(C) for kickbacks to PBMs and GPOs. [4]
  • Repeal the ACA’s prohibition of physician-owned hospitals.[5]
  • Solve “surprise billing” via the arbitration model already working in New York and Texas. Benchmark rate-setting is tantamount to price controls, an anti-free market mechanism with an abysmal track record.

B.   Repeal Onerous, Unnecessary Mandates

  • Remove Electronic Health Record (EHR) and Merit-Based Incentive Payment System (MIPS) mandates for practices having fewer than 50 physicians.
  • Streamline and reform the prior-authorization requirement in Medicare Advantage and other third-party markets.[6]

C.    Mandate Transparency 

  • Codify the measures in the Administration’s two executive orders on transparency.[7] [8]
  • Direct a study by the GAO of the accounting of PBMs ( already a bill), and eventually the GPOs.[9]
  • Mandate transparency regarding the training of all levels of medical practitioner.[10]
  • Make fully transparent the funding that flows FROM pharmacy “channel companies” (such as PBMs, GPOs, and distributors) TO advocacy groups, physicians, and think tanks. This transparency should be retroactive, so as to establish histories of possible conflicts of interest, as called for on page 33 of the white paper referenced in footnote 4.

Bridge to better healthcare:

Reducing Cost and Waste in American Medicine: A physician-led roadmap

IDEAL HEALTHCARE – Freemarket competition to improve quality, decrease price and provide choice for patients

CBO report shows full Obamacare repeal is better than partial, The Hill

https://thehill.com/blogs/pundits-blog/healthcare/317269-obamacare-cbo-report-shows-full-repeal-is-better-than-partial

We should replace Obamacare with a universal tax credit – Forbes, John Goodman

https://www.forbes.com/sites/johngoodman/2015/04/01/why-we-should-replace-obamacare-with-a-universal-health-tax-credit/#735c226529b5

IP4PI Principles for Individual Choice in Healthcare – Independent Physicians for Patient Independence

https://ip4pi.wordpress.com/2017/01/08/mr-trump-here-are-14-solutions-for-ultimate-citizen-consumer-healthcare-choice/


[1] Rep. Roy’s bill: https://www.congress.gov/bill/116th-congress/house-bill/5596?s=1&r=1

[2] Sen. Cruz’s bill: https://www.congress.gov/bill/116th-congress/senate-bill/3112?s=1&r=5

[3] https://www.whitehouse.gov/presidential-actions/presidential-executive-order-promoting-healthcare-choice-competition-across-united-states/

[4] See Appendix B in the white paper: Reducing Cost and Waste: A Physician-Led Roadmap to Patient-Centered Medical Care for a legislative proposal yet to be introduced.

[5] Sen. Lankford’s bill: “Patient Access to Higher Quality Health Care Act of 2019

[6] Rep. DelBene’s bill: https://www.congress.gov/bill/116th-congress/house-bill/3107

[7] https://www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/

[8] https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html

[9] Rep. Marshall’s bill: https://www.congress.gov/bill/116th-congress/house-bill/3223?q=%7B%22search%22%3A%5B%22hr3223%22%5D%7D&s=1&r=1

[10] Rep. Bucshon’s bill https://www.congress.gov/bill/115th-congress/house-bill/3928/all-info

Possible COVID-19 case: Why private independent physicians are a better patient care choice

On Saturday morning at about 10 AM on March 14, I saw a patient for and infectious illness. He was a 51-year-old, military veteran, with a history of hyperlipidemia, cervical DJD, depression and low testosterone. He works as a government entitlement interviewer at a State/county office. His job includes computer data entry while interviewing candidates of all backgrounds for Government benefit eligibility.

He related a two day history of flu like symptoms that included fever with maximum temperature of 102.9°F, muscle aches, fatigue, and dry cough. He denied any history of travel out of the country or exposure to others with that history.  His physical exam was consistent with viral syndrome and negative influenza A and B office testing.  Because of his symptoms, negative influenza testing, and potential workplace exposure history, I was concerned for the possibility of coronavirus Covid 19 Infection. Unfortunately, there were no testing materials for commercially available coronavirus tests. Current testing reports three days turnover time. 

After conversations earlier in the week with Quest and LabCorp, we are on the list to get testing materials next week.  I called the local hospital laboratory and they transferred me to the infectious disease nurse coordinator. She said she would try to get permission to collect a sample from the New Jersey health department and call us back. She called back half an hour later and said that she couldn’t contact anyone and therefore I could not take a sample. 

I was concerned that this might be either COVID19, a false negative influenza test or another infectious illness. My preference was to obtain a viral culture but there were none privately or publicly available, prior to initiation of treatment. As a private independent physician, I decided to treat for two scenarios with Tamiflu 75 twice a day times seven days for influenza and Hydroxychloroquine 200 mg twice a day for seven days as a possible treatment for COVID19. The patient was to self quarantine at home for seven days, stay out of work, and call us with updates. we told the patient to have his live-in girlfriend get in touch with her doctor immediately for potential evaluation and treatment, as she had similar symptoms.

At my direction, my office staff called the New Jersey health department. The number was consistently busy so we sent the patient home. The staff then tried the NJ coronavirus consumer hotline. The attendant said she couldn’t take any information but gave us another number for the NJ COVID19 hotline. 

Upon dialing the next number, we got a polite attendant who also couldn’t take information. I spoke directly with her and she gave me contact information for the County Health Department. I recognized those numbers for daily practice. I knew they would only be available Monday through Friday during business hours and not Saturday morning, which it was. I pressed for another number and was given what appeared to be a cell phone number. 

I called it and spoke with a county health department employee, finally. I discussed the case with her and she said she would call me back after she spoke with her supervisor. She then called back sometime later after the patient had gone and said that given the above case, the New Jersey state coronavirus criteria would not allow a sample to be taken, despite my concerns for moderate risk. 

The major ironies are that the governor, to this moment, despite urging in school closures, has not closed all New Jersey primary schools. Another major irony is that the New Jersey state health department was inaccessible when needed, but coincidentally sent an email with general governance later that afternoon, as opposed to weeks before. 

Fortunately, as a private independent family physician, I was not limited to a hospital system protocol, insurance protocol, or government protocol. I actually diagnosed and treated the patient, definitively and comprehensively, for major disease risk factors.  We will stay in touch with him via phone during the coming week while he is on himself quarantine and out of work. 

LabCorp and Quest Announce Availability of COVID-19 Testing

Quest Announces: Coronavirus (COVID-19) testing now available

As the world leader in diagnostic information services, Quest Diagnostics is committed to fast action on emerging health threats for which laboratory testing can provide critical insights aiding response.  Quest Diagnostics is now able to receive COVID-19 specimens and perform testing. The Quest Diagnostics test for COVID-19 is now available nationally. Patients should be prioritized for testing of COVID-19 if they meet the CDC criteria, including those who may have been exposed to the virus or had contact with someone confirmed to have COVID-19, who show signs and symptoms (eg, fever, cough, difficulty breathing), or who live in or recently traveled to a place where transmission of COVID-19 is prevalent.

Details: ‬‪https://www.questdiagnostics.com/home/Covid-19/

LabCorp Announces: The LabCorp 2019 Novel Coronavirus (COVID-19), NAA test is available for ordering by physicians or other authorized healthcare providers anywhere in the U.S.

LabCorp continues to perform its 2019 Novel Coronavirus (COVID-19) test and to increase test capacity for patients who should be tested. We are working closely with the CDC, FDA and others on a swift response to address this public health crisis. Our team is proud to play an important role as part of an industry consortium that is working every day to meet the growing demand for national testing. Our utmost concern is for the safety of the public, patients, healthcare service providers, and our employees. LabCorp is now able to perform several thousand tests per day and is rapidly adding new equipment and staff to create additional capacity. We continue reviewing all opportunities to expand testing at LabCorp lab facilities across the country.

The LabCorp 2019 Novel Coronavirus (COVID-19), NAA test is available for ordering by physicians or other authorized healthcare providers anywhere in the U.S.

Details: https://www.labcorp.com/tests/139900/2019-novel-coronavirus-covid-19-naa

CDC Incompetence on Coronavirus is Symptomatic of Chronic #BigGovernment DC Swamp

Will the CDC come through for Americans as we face the spread of the Coronavirus? Unfortunately the agency’s performance in these first crucial months is looking anything but competent.

https://www.technologyreview.com/s/615323/why-the-cdc-botched-its-coronavirus-testing/

For “our safety” private labs were initially prohibited by the FDA from testing using their own tests:

The result: while private labs’ hands were tied, the tests the CDC rolled out—the only tests available by government fiat—failed.

After long weeks of delays, the FDA finally freed American innovators to go to work:

Is this President Trump’s fault? Not hardly. His attempts to drain the swamp have been attacked at every turn. While he’s succeeded in many ways, notwithstanding the adverse opposition, the CDC remains firmly controlled by “business as usual” establishment bureaucrats.

The agency has a long history of waste:

Back in 2014 Freedom Works asked the telling question, “Why Does Congress Shower The CDC With Money Despite A Track Record Of Waste and Mission Failure.” While spending lavishly on new headquarters that included a Japanese garden, the CDC was “failing to meet its goals for combating infectious diseases.”

https://www.freedomworks.org/content/why-does-congress-shower-cdc-money-despite-track-record-waste-and-mission-failure

The author’s also highlighted findings from a report that highlighted 15 ways the CDC and NIH wasted $15 Billion dollars of taxpayer funds, on projects like telling Americans how to eat, and funds for Gay activists in public schools

https://www.newsbusters.org/blogs/joseph-rossell/2014/10/16/hey-journalists-15-ways-nih-and-cdc-wasted-taxpayer-money

Another priority for the CDC is apparently making sure teens have condoms.

The hard truth is that the CDC “is a highly politicized organization.”

After dropping the ball on testing, instead of refocusing and making sure it has a laser focus on the problem at hand, the CDC is moving full speed ahead on spending the money Nancy Pelosi insisted on hiding in the “must pass” spending bill passed in December to avoid a government shutdown.

What is the cure for swamp fever? More freedom for our highly competent innovators. Americans cannot depend on entrenched federal bureaucrats. Hopefully the American private sector can once again come to the rescue as they have many times in the past, if DC will let them.