Making American Medicine Great Again in 10 Simple Steps #MAGA

1. Price transparency for all healthcare services and supplies.
2. Site neutral payments (no hospital advantages).
3. Legislation to open and eliminate closed insurance networks. Networks are the third parties strangle-hold noose on healthcare.
4. Care must not be limited by insurance red-tape “referrals,” pre-certifications of imaging tests, and prior authorizations of medicines.
5. Reconsider tax exempt status of hospitals. They should have no advantage over physician offices or other services.
6. Patients should shop for all non emergent healthcare services and supplies and keep their savings.
7. Repeal 1987 GPO PBM anti-kickback safe harbor. Enable freemarket competition.
8. Define DPC as healthcare service contract between patient and facility or physician, not insurance. Keep DPC simple, direct, third party and government free, and patient empowered.
9. HSA expanded for DPC and OTC meds.
10. Legislation to permit physicians to see charity patients in return for either tax deduction or  malpractice insurance.
Two supplementary short editorials:
To solve U.S. healthcare crisis, think small, not big
The American hospital: from volunteer charity to tax-exempt patronage pit
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Less is More: take the deductions for MACRA non-compliance

Friend of IP4PI, Jane Hughes, MD writes in:

Greetings,

Read this BS sent to us by our “professional” organization whose mission is to preserve the profession, etc etc. For the love of God I cannot understand why any physician can’t see by now that this is a fool’s errand and meant to be. Our clarion call should be to all doctors: Take the deductions for non-compliance because: you will save in essence $40,000/yr in compliance costs that would take $430,000 in Medicare payments at the 9% top reward to equal your $40,000 reimbursement before you see a penny in increased payments. More importantly, you can proudly state that you are saving the government (taxpayers) money at the same time. And the best, wait for it- it would go away because no one would be doing it.

This is not to say I have given up on reform. But, to change Medicare we have to straighten out the private sector, and then, with insolvency looming, we can give Medicare ppl a choice- defined monthly contribution (i.e. check like Social Security) or continued traditional Medicare, which would also be a fast disappearing institution with the current costs to “beneficiaries.” Gee, HSAs with no networks, Medicare as catastrophic, and cash pricing versus what we have now… pipe dream worth fighting for. As you can see I almost came off the rails reading this stuff.

Warm regards,
Jane

Forget Pens, How About Banning Kickbacks?

Back in 2008 the Pharmaceutical industry ostensibly took the high road and called for a moratorium on branded items handed out to doctors. No more free pens. Then in 2010 the Physician Payment Sunshine Act cemented in place red tape impeding other gifts to physicians. No more free lunches … with out filling out a form for Uncle Sam.

Well the truth is: “We’ve got big problems in health care, and I don’t think the problem is pens,” stated Houston physician Stephen Lapin, MD, speaking what was on the mind of virtually, if not literally, every physician.

These changes didn’t accomplish much if anything but a few warm fuzzy feelings for politicians, while the folks in C-Suites likely congratulated each other with a slap on the back for yet again shifting the blame onto doctors and covering up their own corruption.

This time doctors are fighting back and asking for real change, change with the potential to save patients to the tune of $100 billion dollars. How? By axing out the Pharmaceutical industry kickbacks being used to bribe the middlemen in control of American’s pharmaceutical benefits.

Your action is needed by July 16 to help end these improper bribes that are driving up costs, creating shortages, and controlling the prescriptions covered by your plan.

Speaking out is easy and instructions can be found here: https://aapsonline.org/alert-and-special-legislative-update-pharmacy-benefits-managers/.

 

AT RISK: Bill to Let Patients Use HSAs for DPC

Earlier this week we heard the good news that H.R. 365 was finally going to be considered by the House Committee on Ways and Means, bringing the use of Health Savings Accounts (HSAs) for Direct Patient Care (DPC) one step closer to reality.

Then we learned “a few small changes” had been made to the bill. Unfortunately the “few small changes” have greatly damaged the legislation.

You can read a copy of the latest bill here: https://goo.gl/B6imgQ.

Under the new language, DPC practices would have to comply with several federal requirements in order to become HSA-eligible. One provision limits the care provided under the agreement to specific CPT codes.  Another would prohibit DPC arrangements priced over a certain threshold from being HSA-eligible. Others further limit how the pricing can be structured and what care can and cannot be included. Specialists would be blocked from offering innovative HSA-eligible monthly membership payment arrangements.

To us, these changes are unacceptable and might be worse than no bill at all. If the bill passes in this form it would put practices that don’t comply with the federal rules at a competitive disadvantage to practices that align their model to satisfy DC instead of their patients.

One more problem:  these changes were tucked in at the last second barely a day ahead of Wednesday’s mark up session of the Bill in House Ways and Means.  That’s right, the new bill is headed to be pushed through committee with little chance for public input.

Today, AAPS sent a letter to every Ways and Means Committee member, and the committee staff, expressing our concerns about this bill and a few other bills the committee will consider on Wednesday, July 11.  Overall, we like a number of the bills under review, because they do expand HSA flexibility. But there are several key problems that tilt the playing field to the advantage of corporate medicine. Read more in our letter here: https://goo.gl/XYutr5.

What can you do?  Please send the committee a message ASAP before Wednesday at 2pm Eastern.  Here are the steps:

1) Copy the following text:

Dear Chairman Brady, Ranking Member Neal, and Members of the House Committee on Ways and Means,

Tomorrow you will be considering replacement language to H.R. 365, the Primary Care Enhancement Act. The addition of improper requirements means the new bill will not accomplish the goal of allowing patients to use their Health Savings Accounts to see the Direct Patient Care physicians of their choice.  I encourage the committee to consider adopting H.R. 365 as written, while rejecting the recent changes. In addition I encourage you to please consider AAPS recommendations about this bill and others you are considering today. The AAPS letter to the committee is available at https://goo.gl/XYutr5.

2) Visit https://waysandmeans.house.gov/contact/ and paste the comment in to the appropriate field and modify as desired.

2a) You can also fax your comment to the committee: (202) 225-2610

3) If your representative is on the Ways and Means Committee, email the note to the Health Legislative Assistant for your Member of Congress. A list of committee members and their health staff contact information, sorted by state, is available here: https://goo.gl/8iqw3u.

Thank you for speaking out!

Cancer research dollars diverted on “study” linking Trump support with opioid abuse?

National Institute of Health funded researchers are hard at work seeking cures for America’s patients… except when they’re not.

The venerable Journal of the American Medical Association is out with a new NIH-funded “original investigation.” What medical breakthroughs are being announced do you ask? Not. A. Single. One. Instead JAMA has published a “study” the authors tout as “adding to the emerging literature on the relationship between health status and support of Donald Trump in the 2016 election.”

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2685627

Here’s what James S. Goodwin, MD et al claim to have “discovered”:

An analysis of a national sample of Medicare claims data found that chronic use of prescription opioid drugs was correlated with support for the Republican candidate in the 2016 US presidential election.

You read that right. Trump supporters are more likely to abuse drugs, according to Dr. Goodwin and his colleagues. However reading through the article, it becomes clear that the boldness of their claim is inversely proportional to the strength of the evidence backing it up.

It’s bad enough that the researchers are digging through and torturing medical data (statistically) for a political purpose. It’s equally bad that the patient data was used without any informed consent (because the data is “de-identified” don’t ya know).

What’s worse? A source of funding for this junk science appears to be a taxpayer funded NIH grant ostensibly for cancer prevention and control.

Whether you support Trump or not, there’s no debate over this: the diversion of cancer research funds for political purposes is bad for patients.  In addition, it is improper to use health crises like the opioid epidemic in this manner. The NIH should demand that the taxpayer dollars spent on this “study” be returned.

Talking to Patients About Guns. A physician says “yes” and “no”

Should doctors routinely talk to patients about gun use?

That was a question my colleague Paul Hsieh MD addressed in the Wall Street Journal over the weekend.

Here’s another slant:

“Yes, physicians should ask about patient gun issues for their health and safety but No, no one should use EHR electronic health records or any data sharing mechanisms for that ultimately private discussion!” – Craig M. Wax DO

What do you think?

Is the hysteria about health insurance covering #pre-existing medical conditions #FakeNews?

Yes. The media hysteria that Republicans want to deny healthcare to Americans with pre-existing health conditions is #FakeNews. And here’s why:

ACA changed the health insurance industry from individual rating to community rating. This is a chief reason premiums have doubled since 2010. With individual rating, a healthy non-smoker pays less than someone that is an unhealthy smoker with cancer; rightfully so. With community rating under ACA, everyone’s insurance costs go up because the unhealthy smokers are often not paying a rate proportionate to the costs they are likely to impose on the system; unfair from a self maintenance perspective. Although ACA purportedly allows the imposition of a “smoker’s penalty” it is not required and a number of states (including California and New York) prohibit higher rates for smokers.

Then came the liberal social justice argument of what shall we do with those that are unhealthy smokers with cancer? The answer that had worked previously to Obamacare were risk pools. People with risk, just like bad drivers with extensive crashes, were assigned to companies to except the risk. ACA Obamacare did away with the risk pools and now everyone is considered a high risk and expensive. From the quality and price perspective, it seems fair to charge everybody the same. From the perspective of self-respect and taking care of oneself, it is completely unfair to rate people in this way.

The latest hysteria on pre-existing insurance coverage is indeed a political strawman argument, not a real issue..