The overwhelming mismanagement of the COVID-19 Crisis

By Paul Kempen, MD, PhD

We saw SARS and MERS as severe Corona infections in the past, and COVID19 is also known as SARS-2:

The 2002–2004 SARS outbreak was an epidemic involving severe acute respiratory syndrome (SARS) caused by SARS-CoV. The outbreak was first identified in FoshanGuangdong, China in November 2002. Over 8,000 people from 29 different countries and territories were infected, and at least 774 died worldwide. We watched it in Torono, Canada, just across the border.

Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath. About 3 or 4 out of every 10 patients reported with MERS have died. Health officials first reported the disease in Saudi Arabia in September 2012.  https://www.cdc.gov/coronavirus/mers/about/index.html

The past epidemics didn’t kill enough Americans to create enough interest in solving the problem. The current SARS or COVID19 pandemic was first documented on January 10, 2020, while the name itself identifies the pandemic as starting in 2019. We are now 3 months INTO the epidemic, with an anticipated death rate of 5% and are still only reacting! Instead of closing down the country, we should have been ramping up industry to provide for THIS EXPECTED pandemic and providing the PPE, drugs material and manpower. The current plan to “self-quarantine” serves only to spread out the ultimate number of infections over time,  to allow the available facilities to be able to “cope” with the expected severe infections. But please remember, that the USA has been reducing total numbers of hospital beds and closing hospitals for decades. It will also remain to be seen if this COVID19 pandemic will equal or exceed the deaths from those yearly Flu season’s infections (epidemics) which KILL 30-60 THOUSAND each year in the USA.

Oddly enough, we never have seen this sort of  PPE response to the flu in  spite of the significant mortality-so why are we treating COVID19 as if it were EBOLA, when it is a respiratory infection just like the FLU? Or will we now be responding to flu seasons like the Covid-shutting down the country, especially if the flu actually kills more people than the covid virus? Why are nurses suddenly utilizing PPE with such high level of protection, exceeding that required for flu season? Why are we seeing nurses crying on TV that “they never signed up for this”. “This” comes EVERY YEAR! The vast majority of flu and COVID patients do NOT die, as many have minimal or no symptoms, especially the young and healthy. Yes, be safe, but in which “War” did this country shut down the industries? Most workers in industry are easily 6 feet from each other.

The LAST place anyone should be going now-if they are healthy, is to a HOSPITAL -why join the infected if YOU are not-stay home!!! All this wasted “news” on testing has been counter-productive. A Test does not save anyone, it does not insure citizens are not infective for a number of reasons-more importantly, you could BECOME infected getting the test in a hospital. Getting yourself tested in your car from a person who is reaching into test hundreds of patients an hour is not someone I want to encounter as they may be infected. Why risk to “see” if I am infected driving up and opening my mouth and possibly GETTING the virus (my test will be negative and I will be positive a day later).  The emphasis on daily declarations of the total number of “cases” rather than DEATHS serves to maintain the hysteria in the population, facilitating and exploiting the fear, to force all citizens to comply with whatever the “Current recommendation” is issued,  being true or false. Testing only provides access for numerators and denominators in the tracking of epidemiology-but this is also an effective way to scare the populace into “following orders”. No person without symptoms needs testing as a matter of acute care. The overwhelming of facilities with hysterical people wanting testing and treatment for “possible” (not probable or symptomatic disease) is counterproductive, helping to spread the disease and tying up those health care workers and facilities need to care for the sick.

The CDC has failed us by stating “civilians should not wear masks”, and should be reversing this statement soon,  because it is WRONG. If it is useful to doctors and nurses, why would it not be true for citizens out in public? Sure, the statement was a political based decision and NOT a doctor-patient decision. The CDC wanted to conserve PPE. Sure, the epidemiologists also have “recommended” for decades to change your face mask after EVERY use before the Covid hit (i.e. every time you leave the operating room)-but no one does this in real life because THAT too is wasteful and excessive. Now we are reusing and prolonged using of PPE because of a shortage, which after 3 months since the first warning, should NOT have occurred.

We as health care professionals-Doctors KNOW what masks do and this is important and is NOT being disseminated via the news. Surgical masks contain YOUR secretions during normal operations from falling into the wound. N95 masks are not the same and prevent other’s aerosol infections from being transmitted to you! A Mask is NOT “a mask”. There are different types, uses and functions. Hand made cloth masks are NOT N95 and protect those around you from your secretions but do not reliably protect you from theirs. Everyone should be wearing surgical masks in public, and “high risk” civilians should have N95 if they NEED to leave their homes to go to the doctor or grocery store. People should not need to reuse masks, but they could be disinfected with rubbing alcohol 70% in a plastic bag overnight and air dried (or even baked at 200 degrees) prior to reuse.

I have YET to see any information on the “NEWS” to explain the use of masks to the public to date. Yet, every hospital health care worker must comply with OSHA guidelines and submit to an “N95 Fitting session” to LEARN how to use this type of “duckbill” N95 mask for PPE!  Because of the misinformation presented on the “daily news” it is high time for these issues to be presented. It is high time for EVERY person appearing on TV to WEAR a surgical mask, whenever there are more than 2 people present! We need the RIGHT messaging sent out to the population and the right example projected!

I have personally Worked on the USNS Comfort twice during missions to South America, once after the Haiti earthquake. ALL patients were screened for Tuberculosis-a  severe respiratory infection- to insure no one with TB was brought onto the ship, because of the danger of widespread infection once on board. The current presence and use of these warship hospitals appear to me to be primarily one of “reassurance” or some political statement in this pre-election period. In this PANdemic however, the likelihood that COVID patients will NOT become apparent onboard-even if they bring only “non-covid tested patients onboard to “relieve landside facilities” is highly unlikely.,  After the 800 workers and first 800 patients are brought onboard, the infection may become apparent after days.  Testing is not able to exclude latent infection and the COVID is extremely infectious-especially if the patients are coming from a high risk zone=i.e. a HOSPITAL. The size of patient bays on those ships is small, the ventilation is “common” and cross infection will be a given, after the first Covid infection manifests onboard. Our experience with quarantine on cruise ships and COVID is,  well…….. nobody is going on a cruise until Covid is over! The resources (personnel and materials) of these two hospital ships would be better placed landside, in a converted mall or convention center with adequate space and ventilation. The shortage is one of material and personnel-NOT floating sardine cans,  which are known to be at risk for dissemination of respiratory infections. These military health care workers should be used landside in this “War on Covid”. We need an army and not a navy today.

The government has made many decisions to allow “compassionate care” approval of drugs. It has been STANDARD PRACTICE to allow doctors to prescribe medicine for “off label” use-prescription for  conditions other than those formally studied and allowed to be advertised under FDA “labeled” guidelines. Almost ALL use of drugs in children was initiated as “off label” for decades. IN the face of an epidemic, the use of hydroxychloroquine had been curtailed and in spite of information from as early as 2004,  suggesting effectiveness in slowing viral reproduction in SARS as a treatment and therapy. Of course the scientists at the CDC “want further study”………….but people are DYING NOW. But the political agenda is to now build thousands of ventilators, instead of releasing drugs. The drugs are quickly and easily marketed, are very low risk in the young and healthy, but alias, as generics these drugs were unlikely to find the financial incentives noted with complex machine products. They may well be able to specifically prevent and treat the disease,  as opposed to fight the symptoms of disease (with ventilators). SARS is not new-it has been there for study for over a DECADE. The lessons of the flu season (epidemics) EVERY YEAR are the same as COVID. Are we learning or even asking these questions? Why not?

Many questions remain in this War and cannot be answered until addressed, unlike most of the preceding matters discussed. Because the young, healthy population is resistant to severe symptoms, should they be restricted from service in this war? Should the elderly and infirm?  Should ALL TV persons be WEARING MASKS to promote the “war effort”? When will educational, instead of hysterical “news” be screened to teach the population what is TRUE and effective? Why are the drugs not in high priority production and dissemination for prescription by physicians to PATIENTS who desire them?

COVID19 is a form of virus (Corona), one which usually causes about 20% of the yearly common colds.  We have not developed testing or immunization for corona virus in the past BECAUSE it is benign. Are children and non-geriatric people less affected, because of their yearly exposures to the similar, yet innocuous corona virus? We know that immunizations for Smallpox, polio and other viral disease prevented these serious diseases by inoculations of similar and less deadly live virus. Infections are typically one pathogen and competition with others may reduce pathogen’s  disease-we know eugenic bacteria exist in the bowel and if destroyed by antibiotics, allow pathogens to become deadly there.  Should we be passing out “Common cold virus” now to compete and possibly prevent severe COVID? Can it “compete” in cell cultures or animals/humans? Should we stop publishing daily “Corvid cases” on the news channels-sticking to deaths and promulgation of useful information like safe and correct mask use for all?

It is time for medical and not political decision making. We should be anticipating needs for now AND the next decade, and not be awaiting each crisis.

Pau Kempen, MD, PhD

213 Vista Dr
Weirton, WV 26062

412 860 6827

“Gee, Jim, I wish I would have run for congress after graduating high school like you! I could have saved myself 12 years of grinding medical education to become an expert in health care like you and your many colleagues in congress!”                                                       From a late night joke on TV

Head of China CDC: 

“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact.”

https://www.sciencemag.org/news/2020/03/not-wearing-masks-protect-against-coronavirus-big-mistake-top-chinese-scientist-says

A physician in Michigan sent this to me last night. 

And separately these Korean modelers concluded that these strategies were working:

“To early end of the COVID-19 epidemic, efforts to reduce the spread of the virus such as social distancing and mask wearing are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through efforts by the quarantine authorities.”

https://www.e-epih.org/journal/view.php?doi=10.4178/epih.e2020011

“Estimating the reproductive number and the outbreak size of Novel Coronavirus disease (COVID-19) using mathematical model in Republic of Korea

Sunhwa Choi Choi  , Moran Ki ,  Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea, Goyang, Korea

COVID-19 Mortality Statistics

By Kelly Victory, M.D., President, Victory Health, LLC.

Like essentially every American with a pulse, I have spent countless hours over the past weeks listening to both politicians and “experts” reporting the “data” and “statistics” on COVID19. Most people now appreciate that testing has been spotty at best and fraught with false negatives, and that therefore, we have likely woefully under-estimate the true number of cases of the virus. 

That said, one of the numbers most frequently reported (daily) — and the one piece of data most commonly cited as a veritable certainty — is the number of deaths from COVID. Well here’s the sobering reality: The numbers being reported by the CDC are wrong. In fact, they are very, very wrong – and here’s why:

We now know that the vast majority (likely greater than 80%) of individuals who contract COVID-19 have minimal if any symptoms. A small percentage (perhaps 5%) go on to have severe illness and may ultimately require supplemental oxygen and/or hospitalization.  Physicians — including the CDC’s own Dr. Anthony Fauci — agree that if and when death occurs as a result of COVID-19, it happens due to “overwhelming cytokine storm and resulting pneumonia and/or ARDS.” In layman‘s terms, people who die from COVID-19 die from pneumonia or from Acute Respiratory Distress Syndrome (ARDS) which is a “pneumonia equivalent“.

In doing a deep dive analysis of the data on the CDC website, I found that only 40% of the patients who have reportedly died of COVID19 actually had evidence of pneumonia. Hmmm.  Only 40%! So, what was the actual cause of death in the majority — the other 60%?? Presumably, it was complications from underlying medical conditions including diabetes, cardiovascular disease, cancer, infection unrelated to COVID19, etc. — In other words, not from COVID-19 at all!

Furthermore, buried in the fine print, I found that in order to be reported as a “death from COVID19”, the patient need not have actually tested positive for the virus; they only needed to have “clinical signs and symptoms consistent with COVID19”. For those who haven’t been bludgeoned with the non-stop public service announcements on the topic, that means fever, cough, headaches, body aches and possibly shortness of breath — symptoms remarkably similar to Influenza and a number of other viral illnesses. 

Given that the “experts” —and the politicians relying heavily on their advice — are making potentially life-altering decisions based on the “growing number of deaths from this virus”, Americans deserve to know what those numbers actually are. Therefore, any patient whose death is being attributed to COVID19 should be required to have documented evidence of both pneumonia and a positive test for COVID19. Anything less represents a continued gross mis-representation of the facts.

https://pjmedia.com/trending/no-the-united-states-does-not-lead-the-world-in-coronavirus-cases-or-deaths/

PETITION: Tell NJ Governor to Rescind Order Blocking Patient Access to Hydroxychloroquine (609) 292-6000

Featured

NEW ACTION ITEM: Sign the petition to NJ Governor Murphy to repeal his prohibition of physician prescriptions for patients impacted by the #COVID19 #Coronavirus #Pandemic.

https://www.change.org/p/phil-murphy-covid-19-nj-gov-murphy-cease-your-prohibition-of-physician-prescriptions

After you sign the petition: Call New Jersey’s governor Murphy (609) 292-6000 to rescind his rule restricting early treatment of COVID-19 coronavirus patients. His rule is dangerous and likely would make people sicker and worsen the death toll. Call him, email or web page contact him and demand he reverse his rule. Let doctors be doctors.

Email: constituent.relations@nj.gov

https://www.nj.gov/governor/contact/

Join the physicians who are speaking out! The below letter from physicians explains the urgency for this request.


Doctor’s Letter to Governor

Dear Governor Murphy,

Based on the current circumstances of an extremely contagious deadly COVID19 virus that is creating chaos in our state and the world, your order to restrict physicians from writing prescriptions to treat their patients with Hydroxychloroquine (HCQ), we believe, is contrary to the best practices of medical care. We, as perhaps you, believe in the sanctity of the patient-physician relationship in personalized individual management and care, and that it must lie in the knowledge and wisdom between those two entities and not artificially imposed by others.

Your administration’s order of restriction to use HCQ, prevents patients’ access to a potential life-saving medicine, especially when administered in the early phase of the disease. (1) Creating such a mandate may risk the lives of many New Jersey residents.

Timely access to these medications may mean the difference between life or death for patients facing the battle of their lives. We respectfully suggest that working with New Jersey’s robust pharmaceutical industry to increase the supply of these drugs, both for NJ and the rest of America would benefit the residents of New Jersey and across the country.

Early treatment is crucial for keeping patients out of the hospital and off ventilators. Delaying treatment results in the opposite, more sick patients ending up in overburdened facilities.
HCQ prevents the virus from gaining access to the human cell and in doing so it prevents the infection. Additionally, in those patients who already have infection in their system, HCQ prevents access to the cellular structure called Endoplasmic Reticulum where it replicates. Preventing such replication, reduces the viral load and hence allows the human immune system to fight off the infection. Without this drug, many valuable human lives will be cut short with such an order as proposed and promulgated by your administration. (2)

Other State Governors of Nevada and Michigan formulated similar mechanisms of restrictions to the use of Hydroxychloroquine but seeing the burgeoning loss of life quickly reversed course. If restriction is to prevent hoarding of the medication, then perhaps using the Texas model of limiting the drug dosing for 10 days (20 pills) might be more appropriate. It prevents harm to our vulnerable, sick and infirmed patients. (3)

HCQ has many decades of history as used in the care of patients with Malaria and Rheumatoid Arthritis. Knowing its very low toxicity and it poses very little if any threat to the patient, clinicians in New York, Kansas, elsewhere are reportedly preventing deaths and ARDS/ventilator dependent long ICU stays. Waiting for placebo-controlled trials is not a wartime battlefield strategy, given the urgency of treatment.

As physicians it is our duty to treat patients with the best available therapy and available evidence to circumvent disease at its earliest phase, so as to prevent the loss of life and any future morbidity. It is with that wisdom and acquired knowledge that we respectfully ask you to reconsider this restrictive mandate.

That these drugs are effective against COVID-19 has been proven in laboratory experiments. (4) And now evidence is mounting that these drugs are working to decrease viral load in patients. Decreased viral loads means patients not only avoid the hospital but are less infectious to others.(1) There is growing evidence that early administration even in mild cases of COVID-19 prevents progression to worse disease, likely attenuating the need for ventilators and ICU beds and improves symptoms. (5) This will decrease the burden on the healthcare system and upon the doctors and nurses that bear the ultimately responsibility of the patient’s care.

The information available from across the world suggests that the prudent course of action is not to put hurdles in the path of patient care by restricting most valuable medications that can protect a human life. In fact, India is officially recommending health care professionals and family members of sick patients prophylactically take HCQ. (6) The New York Times reports of a recent study: “Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug.” (7)

We respectfully ask that you review this decision, given the influence of such overwhelming evidence to the contrary. It is with great respect and urgency that we ask you to reconsider this decision that can potentially cause a significant loss of life in the state of New Jersey. Each patient care decision is unique to an individual and their own personal situation and value system. Patients and their physicians must carefully weigh the risks and benefits of every potential intervention. The confidential patient-physician relationship must be held sacrosanct for this purpose.

Best health,

Craig M. Wax DO, Family Medicine
Parvez Dara, MD, Hematology/Oncology
Jim Thomas, MD, Interventional Radiology
Theresa Thomas, MD
Joeseph J. Fallon, Jr., MD, Endocrinology
Carl J. Minniti Jr., MD Medical Oncology & Hematology
Charles Dietzek, DO Vascular Surgery
Indrani Sen Hightower, MD, Neurology
Alieta Eck, MD, Family Medicine
Kelly Victory, MD, Trauma and Emergency Medicine,
Disaster Preparedness and Response
Christine Saba, MD, Pediatrics
Kim Legg Corba, DO, Family Medicine
Marion Mass, MD, Pediatrics
Katerina Lindley, DO, Family Medicine
Theresa Thomas, MD, Internal Medicine
Thomas W Kendall, MD
Family Medicine
Robert Campbell MD
Anesthesiology
Pain Management
Jane Hughes, MD, Ophthalmology
Kris Held, MD, Ophthalmology
Michael J. A. Robb, M.D., Oto-Neurology

Marilyn M. Singleton, MD, Anesthesiology

Kenneth A. Fisher, M.D. Nephrologist

Marlene J. Wust-Smith, M.D., Pediatrician

Leah Huston, MD, Emergency Medicine

Karladine Graves, DO, Family Medicine

Elaina George, MD, Ear Nose Throat

Scott Stevens, MD, Ophthalmology

N. Lois Adams, B. Pharm, MBA, CRPh

Joel L. Strom, D.D.S.,M.S., General Dentistry
Independent Physicians for Patient Independence

References:

  1. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial
  2. COVID-19 Drug Therapy – Potential Options
  3. Gov. Whitner reverses course on coronavirus drugs
  4. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro
  5. Efficacy of hydroxychloroquine in patients with COVID-19
  6. Recommendation for empiric use of hydroxy-chloroquine for prophylaxis of SARS-CoV-2 infection
  7. Malaria Drug Helps Virus Patients Improve, in Small Study

https://www.senatenj.com/index.php/pennacchio/growing-number-of-doctors-agree-with-senator-pennacchio/47292

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!

The Truth About 22 “Studies” that Claim “Medicare For All” Would Save Money

There’s a lot not being revealed in a recent oped in The Hill touting new “evidence” that “Medicare for All” would be a financial boon.

https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money

For example:

PLOS Survey Is A Selective Review Of Prior Studies From Single Payer Proponents

  • The authors of the PLOS survey used a flawed and incomplete review process that only included studies supporting implementation of Medicare for All, rather than comprehensively and objectively examining the significant economic impact and other negative tradeoffs of single-payer proposals.
  • The PLOS survey included 22 studies, more than half of which were written by the same four authors, some of which dated back to 1991.
  • The PLOS survey excluded 35 studies of single payer proposals.

The Nonpartisan Congressional Budget Office (CBO) Found Medicare For All Would Reduce Access To Care And Eliminate Choice For Consumers, While Dramatically Increasing Federal Spending At A Time Of Record Deficits And Debt 

https://americashealthcarefuture.org/new-plos-survey-provides-a-biased-and-flawed-overview-of-medicare-for-all/

The oped also flat out ignores history.

Looking at NHS spending in the UK  over time puts to rest any claim that government run medicine is economical.

And here is spending per capita adjusted for inflation:

Not to mention, the author disproves her own point by concluding, “The government already pays for about two-thirds of health care costs.”

We already largely have a single payer system and it hasn’t achieved lower costs. Will pushing the remaining third under government control make things better or exacerbate the existing problems.

The expectation that spending will drop when patients do not pay deductibles or coinsurance flies in the face of basic economic theory.

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

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.

HR 3708: Is Pre-Deductible Coverage of Direct Primary Care a Feature or a Bug of The Primary Care Enhancement Act?

Aren’t HSAs intended to empower patient choice? Enabling plans and employers to influence the patient’s selection of primary care physician seems antithetical to this purpose.


DPC practices are rightly concerned about the numerous limitations HR 3708 would impose on their innovative model.  Yet, the limitations on HSA-eligible DPC arrangements are needed “to keep the cost score estimate of the legislation down,” the flawed argument goes.

But the tax impact occurs when dollars are put into an HSA and not when they are spent, so why so much fuss? Yes, the bill would cause more people to become eligible to fund their HSAs tax-free. That would indeed be a source of lost tax revenue. However, wouldn’t the cost in lost tax revenue be about the same irrespective of how a DPC arrangement is designed, assuming patients are funding their HSA up to the modest limits allowed per year anyhow?

Continue reading

ACTION ALERT: STOP Legislators from Delaying Patient Access to Physicians and Facilities of Their Choice

NO To New Jersey Assembly Bill A5369 & S3816!

Following the example of Congress, the NJ Legislature has introduced a “Patient Protection Act” (A5369 / S3816) that is anything but protective of patient rights.

According to NJ Spotlight, “the proposal has drawn criticism from patient advocates and other healthcare experts who suggest that, in an effort to protect the business interests of Garden State hospitals, it could put patients in danger.”

What does this bill do? It erects a number of bureaucratic requirements that physicians would be required to fulfill before referring a patient to an out-of-state colleague or facility for needed medical care.

Here’s how Joe Nessa, Esq. explains it:

If passed, this legislation could have a devastating effect on patient care. Currently, physicians in New Jersey are free to refer their patients to world-renowned hospitals in Philadelphia, New York City, and across the nation for treatment. New rules imposed by the bill would require physicians to inform patients of the availability of in-state facilities even if they think their patient can receive better care elsewhere, notify the patient’s insurance company of the out-of-state transfer, and report the transfer or referral to the Department of Health. This addition of paperwork and red-tape will force physicians to make the easier, time-friendly decision of keeping their patients in-state, regardless of their thoughts on quality of care. Additionally, as if the above requirements aren’t enough, physicians would also be required to send quarterly reports of each out-of-state referral to their licensing board, accompanied by an explanation of the clinical necessity.

Earlier this summer, this bad legislation was being fast-tracked through the legislative process, and was quickly passed by the Assembly and a Senate Committee. It “has yet to be approved by the [full] Senate,” reports the Fall 2019 Edition of MDAdvisor. However, “[t]he sponsors are continuing to work on this legislation….”

Your help is needed to help STOP A5369 & S3816!  Here’s what you can do:

Call your NJ State Senator and Assembly Members. Tell them you are depending on them to stand up for patient rights and vote NO on A5369 and S3816. Patient care should not be put at risk to benefit the bottom line of special interests.

You can find their phone contact information here:
https://www.njleg.state.nj.us/members/abcroster.asp

If you don’t know who represents you, the legislature has tools to help you find out here:
https://www.njleg.state.nj.us/members/legsearch.asp

Medical facilities in NY and PA have put together a tool for sending e-mail messages to legislators which you might also consider using:
https://actnow.io/Y1rtnGO

Thank you for speaking out! Your voice makes a difference.

Update: AAFP Should Stand Up for Patient Access to Independent DPC and Withdraw Support for HR 3708

Update: Here is Mr. Shawn Martin’s reply. He granted permission for IP4PI to share it with the understanding that it should not be considered an official statement from the AAFP.

On Oct 25, 2019, at 7:17 AM, Shawn Martin wrote:

Craig-

Thank you for your email. I hope you are doing well. Your email outlines several areas of concern that we share and have been communicating to the various bill sponsors and Committees. We are working to make changes to the bill and I am confident that we will be able to do so.

AAFP policy only speaks to the allowable use of HSA funds for the periodic payment for primary care DPC practice. The bill language meets this objective. We are, however, very concerned with the exclusionary definition of services, specifically pharmaceuticals. Family physicians are not homogenous and the inclusion of a standardized definition and payment rate for “primary care” is concerning. We also are concerned that the allowable periodic payment amount is established irrespective of the patient and their health condition(s).

The other concern we are advancing is the simple fact that the language would apply the permissible use of the HSA to the periodic payment and not the patient themselves. This is nuanced, but basically the permissible amount should apply only to the patient/HSA holder and should have no impact on the practice or the practice’s financial operations.

There are other structural issues, but these are the big items we are working on.

Have a nice weekend – SM

Update 2: From: Shawn Martin, Date: October 25, 2019 at 2:06:39 PM EDT

October 25, 2019 at 2:06:39 PM EDT

I think the challenge in the next few weeks is this – is there a pathway to codify the permissible use of HSA funds for the explicit purpose of periodic membership payments and, if yes, what is the scope of services for such a permissible payment.

The relationship between not permissible (current) and permissible at $x (as proposed in legislation) is not the point in my mind.  The point is providing clarity in statute that an individual may use their HSA funds for a defined purpose – in this case periodic payments to a DPC practice.  Any limitation on the amount of a permissible expenditure is secondary to the permissibility question more generally.  There are defined limits on tax advantage accounts broadly – FSA, CTC, mortgage deduction, SALT, etc.

Its an interesting policy question that I have been kicking around since the ACA.  The HRA is cleaner because it is a defined contribution.  Anyway – look forward to the call with you and others.


10/24/2019 letter from IP4PI founder Craig M. Wax, DO to AAFP Senior Vice President for Advocacy, Practice Advancement and Policy, Shawn Martin:

Dear Shawn

Long time no see, or hear for that matter. I hope you and your family are well and that you landed safely at another entity. I’m writing to express concern about HR 3708 in the House and AAFP support of it. AAFP has been supportive of DPC in recent past and that support is much appreciated, but this bill, as written, would do more harm than good.

Enacting an aggregate cap on patient use of HSA funds for access to value-based care would be a bad precedent and the proposed prohibition on the ability of physicians to include medications in a DPC agreement is contrary to the best interests of patients.

In addition, all specialties, not just primary care, should be permitted to arrange innovative direct payment arrangements with the patient, eliminating the middleman and optimizing care with reduced cost.  HR 3708 appears to preclude the ability of a patient with diabetes from using HSA funds to pay for a monthly arrangement with an endocrinologist, for instance.

The bill also seems to risk the potential for States and others to misclassify DPC as an insurance plan by not properly and clearly defining DPC as medical care.

In its current form, this bill is unacceptable and I am disappointed that AAFP is supporting it. The previous Primary Care Enhancement Act from 2017 (HR 365) was an excellent template, while HR 3708 is flawed.

Please let me know what can be done to revoke AAFP support for this harmful legislation, and work for better options to support DPC and empower both physician and patient independence.

Best wishes for good health,
Craig M. Wax, DO
Family Physician
Independent physicians for patient independence
National Physicians Council on Healthcare Policy member
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax