MOC Feeds Big Data, Means Big Dollars, and Patients Suffer

It’s all tied together… Because pushing MOC on us is how they’re able to collect data… And the PBM’s, a.k.a. Optum, CVS, express scripts are big data collectors. So are the GPO…Granddaddy GPO Premire is the MOC data collector. 

Another facet: Pharmacist prescribing….The big box pharmacies are totally behind the dumbing down of who can prescribe.  Physicians have become an un-necessary tool.  The big boxers need an army of new pawns…. 

If you dig around CVS’s website you’ll discover they are offering scholarships for employees to go to pharmacy school.

Meanwhile, Walmart trains low level admin for $1 a day. (Warning- have nitro handy before you read this next link:) https://www.fiercehealthcare.com/finance/a-focus-primary-care-clinics-walmart-offering-its-employees-healthcare-workforce-education 

Walmart, the WORLD’s LARGEST company by revenue is about to subsidize the EXPANSION of a dumbed-down administrative state (is that even possible?) and add to optometry and pharmacy tech degrees.  

CVS now taking over PBM role for Walmart https://cvshealth.com/newsroom/press-releases/cvs-health-and-walmart-announce-new-pbm-pharmacy-network-agreement

And on top of it all, CVS and it’s vertical mergers are a wealth (literally) of conflicts of interests that perpetuate all of the above and more: https://thehill.com/opinion/healthcare/421697-put-the-brakes-on-the-cvs-and-aetna-merger-to-sustain-competition-and

Insurers going into the drug manufacturing business? Imagine Hershey starting a milk farm.

Friend of IP4PI Bob Campbell, MD writes in:

BCBS announced this week it is planning to become a manufacturer of generic drugs. This bizarre market behavior is a direct result of the anti competitive secret contracts. It is not at all how normal markets work. 

Hershey Foods is based in my town. Let’s say cocoa beans and milk and almonds and sugar were unavailable due to some form of anticompetitive cartel. Hershey might buy land in Africa and start cocoa bean farms and buy land in Brazil and begin growing sugar cane and buy land in Iowa and stock it with dairy cows and buy land in California and plant almond trees. The problem here is they do not have the resources experience and expertise to do this well. They know nothing about almond farms and nothing about African politics and farm workers.

Markets encourage efficient specialization. This lowers cost and improves the value equation for the customer. Free markets enhance supply chain productivity.  Think if Dow chemical had to drill for its own oil to make its plastics and materials. They know nothing about drilling for oil. Bad for Dow and bad for consumers.

Insurance companies last time I checked were not running their industry very well. I pay a $27k per year premium for embarrassingly bad coverage. They should fix their own industry before they become a pharmaceutical manufacturer. This bizarre inefficient market behavior is a predictable outcome with the Safe harbor in place. It is what is called a broken marketplace.

Read the American Antitrust Institute White Paper on the GPO/PBM Safe Harbor. The drug shortages are a predictable outcome. They will persist as long as the safe harbor for racketeering persists. 

Bloomberg just came out in favor of eliminating all PBM kickbacks. He said we will make pharma manufacturers compete again with no payments to PBMs distorting the marketplace. Remember Azar our in a new fixed rate kickback to replace the traditional % of revenue kickback in the Trump PBM Rule. Trump does not want to be seen backing down from his prescription to lower prescription costs plan and he does not want to have a Bloomberg lite watered down plan. Trump should be even more bold than Bloomberg in this issue. 

Another everyday PBM failure; patient forced to be without meds

A physician-friend of IP4PI reports:

Our senior age patient with a Medicare Part D plan from @ExpressScripts mailed in a controlled substance prescription to the Express Scripts Mail Order Pharmacy on 01/13/20.

Two weeks later? The patient has not received the medicine and is unable to transfer the script to a different pharmacy. The patient called Express Scripts and logged onto their website to find that the plan received the Rx on 01/20/20.

We called Express Scripts. After being on hold for 15 min, Barbara R, said she was on the commercial side and couldn’t help with Medicare claims and put us back on hold. Then, we talked to Jerry C., a supervisor who informed us, in a condescending manner, that Express Scripts recorded that they received the Rx (erroneously) on January 26 it wouldn’t be ready for shipment for another week after today (01/27/20).

Yet another #PBM failure.

I had to give the patient another controlled script he could fill at local pharmacy. PBM added cost to all parties in terms of time and money, and another Rx for a controlled substance for the government to complain about.

The ACP Vision: Compulsory Single-Payer System

Comrades,

ACP (or should it be ACCCP) has proposed “a bold new plan,” Vice-Premier of Government Affairs, Bob Ilyich Doherty announced last week. 50+ years of a Cold War on American health care have not yet succeeded in complete elimination of medical freedom..

To finish the job, ACP has released its detailed plan to achieve “universal coverage.” Whether the plan will require sending private physicians to the gulag for re-education to become loyal hospital employee and health plan party members has not yet been disclosed.

AAPS reports on what is in the plan:

“This proposal is a 180-degree shift from the American Medical Association’s stand in 1965, when it proclaimed that ‘The voluntary way is the American way,’” states AAPS executive director Jane M. Orient, M.D. “Reading the actual plan reveals that it is the involuntary way.” She points to key provisions:

  • “The ACP believes that to achieve true universal coverage, coverage must be compulsory.”
  • “Enrollment in any new U.S. system must be mandatory.”
  • “The ACP opposes the sale of duplicative coverage.”

According to ACP senior vice president Robert Doherty, the organization still envisions a limited potential role for private supplemental insurance in its preferred single-payer model. Dr. Orient points out that this means people could get coverage for luxury services like cosmetic surgery but would be restricted to the government-funded plan for life-saving services—as in Canada and in U.S. Medicare for the elderly.

For inevitable cost overruns, ACP supports a global budgeting model: “the process by which society chooses, directs, and enforces how much to spend on health care, what to spend it on, and where that spending will take place.” In Canada, this means that when the budget is exhausted, the operating room closes, Dr. Orient noted.

ACP plans to reduce administrative costs through a government takeover, but Dr. Orient states that Medicare grossly understates administrative costs and shifts them to the private sector. Moreover, the Department of Justice claims that there have been $19 billion in fraudulent Medicare charges since 2007.

The death-panel equivalent is palliative care, observes Dr. Orient. ACP states: “One quarter of Medicare dollars are spent during the last year of a beneficiary’s life…. Palliative care has been shown to reduce costs, particularly in the hospital setting.”

“Patients need to be in control,” Dr. Orient. “They must not put their lives in the hands of government or ACP bureaucrats. They need freedom-based solutions, as outlined in an AAPS white paper.”

The Certified Deceit and Exploitation of US Physicians

Guest Post by Wes Fisher, MD

For the past seven years, I have devoted a significant amount of my time to investigating and telling the true story of US physician “board certification.” That story has been one of deceit, private back-room deals, profiteering, and (worst of all in my humble opinion), the exploitation of working physicians and the patients for whom they care.

This writing has not come without its personal and professional costs, but when the story is one that affects the corruption of the largest single contributor to the US economy, what else should I have expected?

As I reflect on what this side job has exposed, it would be naive and dishonest to suggest that physicians are exempt from bearing some responsibility for rising healthcare costs in America. But it may go much further than that: our medical profession and its hallowed physician education regulatory system comprised of the unchecked Accreditation Council for Graduate Medical Education (ACGME) might be the very reason things were allowed to become so out of control. Our non-profit tax laws with their opaque reporting requirements have allowed huge “non-profits” to go unchecked in America – and most of those “non-profits” are in healthcare. (Just take a stroll by the American Medical Association (AMA) building in downtown Chicago sometime to get a feel for the magnitude of the problem.)

Why should the physician education and credentialing systems in America be exempt from such corruption?

Well, they are not.

From the earliest reports of a multi-million dollar condominium purchase by the same non-profit organization that created the “Choosing Wisely®” campaign to promote health care cost savings, the hypocrisy of US board certification was laid bare.

Read full article: https://drwes.blogspot.com/2020/01/the-certified-deceit-and-exploitation.html

Malpractice Costs Will Soar if NPs are Deemed On Par With Physicians

Dear Administrator Verma,

Deeming non-physicians to be essentially equal in training and experience to physicians amounts to a dangerous experiment on American patients. It is improper and unethical for the federal government to be making such decisions regarding the scope of practice of medical professionals.

I have spent over 40 years as a complex litigation specialist. Handling over 35,000 malpractice claims. It seems the law of unintended consequences is at play. Currently the “Captain of the Ship” doctrine limits liability to allied health personnel. It also limits professional and legal liability costs. Placing nurse practitioners and Physician assistants on par will indeed lead to greater claim frequency and increased legal costs. Rates for all providers will increase. In fact underwriters will increase offices with PA’s and NP’s. We could see malpractice costs for internal medicine practices rise from $1-3,000 to $9-12,000 per allied health professional .

We saw the law of unintended consequences occur with EHR and once down that “rabbit hole” there is no return. There is both a patient and physician expense that has not been calculated.

Likewise it is irrational and counterproductive to pay a minimally trained person the same as a highly trained, experienced person. If the reimbursement is the same for poor quality as for good quality, but the poor quality costs less to provide, the entities that degrade quality have a competitive economic advantage. Medicare’s existing price controls are already impeding patient access to high quality care and should not be exacerbated by additional flawed policies that further disregard important differences between practitioners. 

The bottom line is that patients’ lives are at risk. The federal government should follow a policy of “first do no harm.” It violates this principle to impose top-down edicts declaring that non-physicians are qualified to practice medicine. I urge the federal government to reject such policies.

Peter Leone

President, Edge Professional Liability Services https://edgepro.net/

Non-physicians Practicing Medicine is Dangerous and Deceptive

CMS wants more input on scope of practice regulations, reports Health Leaders Media.

Take a few minutes and write a comment.  Tell CMS that non physicians practicing medicine is dangerous and deceptive.  There will be unintended consequences of diminished medical school attendees and mass firing of employed physicians for cheaper substitutes.  Nursing is Not Medicine and it is deceptive for hospitals to deny patients access to physicians. 

Comments should be sent to PatientsOverPaperwork@cms.hhs.gov with the phrase “Scope of Practice” in the subject line by Jan. 17, 2020.

We need your voice.  Its now or never.  If Section 5 is not removed…your tomorrow will be a very different world.

Additional Resources:

“There are absolutely no validated scientific studies that have shown the safety and efficacy of non-physicians [with as little as 3% of the training of physicians] practicing independently of physician supervision.”

https://www.physiciansforpatientprotection.org/ppp-responds-to-executive-order-regarding-pay-parity-and-scope-of-practice-offers-solutions/

“After residency, a physician has accrued a minimum of 20,000 or more hours of clinical experience, while a DNP only needs 1,000 patient contact hours to graduate.”

https://www.physiciansforpatientprotection.org/md-vs-dnp-the-difference-of-20000-hours/

“Compare the Education Gaps Between Primary Care Physicians and Nurse Practitioners”

https://www.tafp.org/Media/Default/Downloads/advocacy/scope-education.pdf