It is not only Aetna, but every major health insurer.

To: Mr. David Jones
Insurance Commissioner of California

Dear Mr. Jones:
I and many of my physician colleagues were gratified to learn in the news this week that you are opening an investigation into Aetna’s ‘prior auth’ practices. I share this little story from today, just so you know it is not only Aetna, but every major health insurer. This is a major reason why our country’s health care is the most expensive, and among the least productive in the developed world (the reverse of just a few years ago), and why U.S. life expectancy has now declined for the second year in a row. I have cc some great physician leaders that I have worked with in California.
Thanks,

Michael Strickland, MD
letmydoctorpractice.org

This is how tests were ordered 10 yrs ago:

Dr to staff: Get a Cat scan (CTPA) of the chest scheduled asap on this patient with recurrent chest pain (who called me last night with worsening pain), now coughing up small amounts of blood (which could become large amounts, at any time, until we know what is causing it), with abnormal fluid collection (pleural effusion).
Minutes later:
Staff: CT scheduled for 9 a.m. tomorrow.
Dr : Great. Next patient..

In 2018:

Tues afternoon:
Dr. to staff (above)
Wed. a.m., I haven’t heard when scheduled. Ask staff. “Hasn’t been scheduled yet. Anthem says it will take a couple of days for them to decide if this test is necessary.” (Note that if the patient gets CT done today and we find a problem, we still have time to do something about it. If Anthem approves it for Friday at 4 pm, there will likely be nothing we can do until Monday..assuming it has not become an emergency, during the delay.)
I call Anthem at 888-224-4902. Get transfer to “provider svcs” 800-345-4344. Get told I need to hang up and call ‘peer to peer line’ at 866-876-3184.

When I call, get voice mail that says “leave your information, and someone will get back to you WITHIN 30 DAYS” !!!!! (I left some information alright).

Call 1st no. back, tell them I want this test approved NOW, or get a Dr. or RN on the phone with me now, or I will send the patient to the ER, and Anthem can pay $5000 to get this done. (Then I remember, the patient has a $12,000 deductible. So, why is Anthem even involved?? “Oh, we still have to approve.”) An RN comes on the line. After a few moments, she says, “Well, a ‘case’ hasn’t been started yet. Your staff will need to call 800-554-0580.” I thank her for her help, tell her this is why I practice direct patient care and do not accept insurance, and ask if she’s seen the news this week that the state of California is investigating Anthem (oops, Aetna. Same thing) over its prior authorization practices.

Give staff above no. She calls and gets CT scan “approved”.

I spent 25 min total on phone w Anthem, plus 15 min w patient and staff, plus documenting (in case of bad outcome, d/t delay), i.e. about one hour of my (doctor’s) time, and staff tells me she spent about an hour on this as well, so 2 hours of the clinic’s time to get “approval” for a test that any 4th year med student would immediately know needs done, and needs done now. And 2 hours we did not do anything remotely resembling anything productive to patient care.

If you wonder why you can’t get into your doctor for days or weeks, and why it costs a fortune, look no further. This happens all day, every day, in every doctor’s office across America.

Next patient…never mind, I’m going to take an aspirin and lie down for a few minutes.

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“Continuing Board Certification” sounds swell but harms patients.

Dr. Walter Wood writes:

I board certified prior to 1991 and have “lifetime” certification equivalent to an academic degree. I can attest that my younger colleagues and their patients are being harmed by costly and time consuming “requirements” to participate in “re-certification” and “maintenance” of certification, soon to be renamed “Continuing Board Certification,” which is not needed and not only does not help patients but harms them. Patients in need are harmed when a doctor is not taking care of patients because the doctor is busy preparing for or repeatedly jumping through hoops such as what lawyers experience once in a lifetime with their bar exam. I was somewhat stunned that an anti-trust judge thought it was necessary to demonstrate “harm to consumers” as a result of the egregious behavior of the ABMS and its colluding member boards. That judge needs to be asked whether s/he repeats the bar exam every ten years.

Walter Wood, MD, FAAD

P.S. I have posted these comments at certificationharm.org.

Pioneers and Powerhouses of DPC launch new organization

The Direct Primary Care Alliance launched on January 1, 2018 as a physician-led organization exclusively focused on growing the Direct Primary Care (DPC) movement. The Alliance was born from a grassroots network of practicing DPC physicians looking to provide a unified voice and resources for fellow DPC physicians. The motivations for launching the Alliance can be found in remarks from our inaugural president, W. Ryan Neuhofel, DO, MPH:

We now realize the transformative potential of the DPC model and are at the advent of moving beyond novelty.  But, many hurdles exist for us to achieve that vision. The challenges ahead of us are immense. Yet I can think of no better group of people to overcome these odds.


Trump Executive Order Births Sweeping New Rules Allowing Association Health Plans

From our friends at D4PC:

The Trump administration, encouraged by Senator Rand Paul, circumvented Congress with Executive Order 13813 to create rules through the Department of Labor that allow approximately 44 million Americans to create and/or join Association Health Plans (AHP).

These AHP are exempt from many of the ObamaCare mandates that have been cost drivers for the insurance policies offered to self-employed and small businesses that often doubled rates.

“The proposed rule is designed to make it easier for groups of individuals and small businesses to band together and buy the kind of insurance that large companies offer their workers. That kind of insurance is regulated under federal labor law and isn’t subject to all the requirements and consumer protections that apply to individual and small business insurance under ObamaCare.” -NYtimes.com

The sweeping new rules have been published for public comment for 60 days before they are implemented with the force of law.

Click here to read more.

Not news to physicians, but the media is finally seeing through EHR smokescreen

Others’ eyes are finally opening to what physicians have been seeing for years: EHR billing and compliance IT only adds to healthcare costs not quality, economy or patient satisfaction.

In 2016 Forbes reported that “U.S physician costs to keep up [with HIT] have reached more than $32,000 per doctor annually.”

https://www.forbes.com/sites/brucejapsen/2016/08/10/health-it-costs-surpass-32k-per-doctor-annually/amp/

IP4PI founder, Craig M. Wax, D.O., has been writing and speaking on this for the better part of this decade.  Here are just a few of his talks about EHR’s attack on patient care:

EHR privacy and security: mission impossible (patient town hall version 2012)

EHR privacy and security: mission impossible (physician version 2012)

EHR the Trojan horse (2014)

EHR remote control (2014)

This is How You Fix Congress! Congress Reform Act of 2018

We originally posted this solution back in 2013. These changes are needed now more than ever:

1. Congress must equally abide by all laws they impose on the American people.

2. No Tenure / No Pension.  A Congressman/woman collects a salary while in office and receives no pay or any other benefits when they’ve completed their term in office.

3.  Congress loses their current taxpayer paid health care insurance during and after tenure and must purchase their own health care insurance by the same laws and rules as the American people.

4.  Members of Congress can purchase their own retirement plan, just as all Americans do.

Continue reading

We Need Your Feedback! U.S. Physician Board Certification Survey

Practicing Physicians of America is excited to bring you an important survey to gather information needed to provide data backed, counter arguments to the unsubstantiated claims used by the American Board of Medical Specialties to continue to promulgate their MOC product.

This survey has the potential to be the largest and most authoritative of its kind but not without your help.

Please take 10 minutes of your time to complete this survey and provide us data to defend practicing physicians at a national level against intrusion into our profession. Then share, tag, copy and email this to colleagues. You may use my words and my name. I will fight tooth and nail to be unfettered from those in healthcare that put profits over patients.

We wish you good health, prosperity as we all negotiate the changing environment of 2018!

https://www.surveymonkey.com/r/PPA_MOCSurvey

Marion Mass, M.D. 

Philadelphia area Pediatrician
Practicing Physicians of America, co founder/VP http://practicingphysician.org