CMS released a county-level map of 2018 projected ACA Exchanges participation:
“This map shows that insurance options on the Exchanges continue to disappear. Plan options are down from last year and, in some areas, Americans will have no coverage options on the Exchanges, based on the current data.”
“This is yet another failing report card for the Exchanges. The American people have fewer insurance choices and in some counties no choice at all. CMS is working with state departments of insurance and issuers to find ways to provide relief and help restore access to healthcare plans, but our actions are by no means a long-term solution to the problems we’re seeing with the Insurance Exchanges,” explains CMS Administrator Seema Verma.
Friend of IP4PI Jane Hughes, MD writes in:
Anyone who thought that things were on hold regarding continued implementation of ACA and the statist move by Medicare via MACRA and its payment scheme called MIPS to centralize and control patient and physician choices needs to read this upcoming offering for unprecedented free CME from one of our premier institutions, Johns Hopkins. Key to centralization is electronic medical records that are interoperable. Read that to mean 24/7 access by government/insurance for data gathering and eventual treatment rubrics. Note that all of these CME hours are not featuring medical or surgical issues, they deal with “educating” and indoctrinating physicians on the advisability of population based care.
This is a sinister turn for the worse. We should have gotten a health plan through in some form to start the dismantling of ACA and trumpet the message that this is the beginning of decentralizing healthcare. Critical to reform of Medicare and getting rid of MACRA is a stable, affordable, and accessible private option.
These sponsoring organizations are proceeding as if nothing has changed. Until Trump appointees get rid of entrenched bureaucrats subversive to the true reform of statist ACA this is no surprise. The collusion with insurance and govt also needs to be exposed. These two forces are insatiable looters of tax monies, people’s premium moneys, individual human dignity, and doctor and physician choices. Note they are offering 58 hours of CME credit/brainwashing. What an impotent feeling to read that even an institution as grand as John Hopkins has succumbed to the George Orwell form of medical care.
The insurance and government dominated system is failing our patients. A physician friend of IP4PI shares this shocking example about the system claiming another victim:
A 59 y/o man presented to my last employed practice, with an almost elephantiasis swelling bilateral legs. He had pinpoint marks on the skin of his legs. He held up a jar with what looked like a couple of tiny maggots. He said, these come out of those holes every so often. I said how long has this been going on?? He said 1.5 years. “I’ve mentioned to several doctors, they just shrug and don’t do anything.” I said we would do something, and called the hospitalist immediately to admit for workup and treatment. I was directed to the nurse gatekeeper for approval for admission. What’s wrong, she asked. “4+ edema in both legs, which are also full of maggots.” Hmmm, she said. There is no medicare admissible diagnosis of ‘maggots in legs’. What about his rising creatinine of 1.7? Not bad enough to qualify under guidelines. Call us back if it gets worse. I did try to do some outpatient workup, but I think the man was disgusted. He never followed up. He was dead within the year.
Friend of IP4PI Charles “Chip” Smutny, DO writes in:
Does anyone think about or have we even tried to come up with our own physician based contract proposal to insurers that could be a way of negotiating our independence as an alternative to their railroading contracts? Since we know that DPC works, cost less and provides better care more efficiently and that insurance will morph to continue to keep its revenue stream, perhaps we should offer up a contract of our own.
Since we don’t like their offer should we have a counter proposal that requests what we want in a legal document that can be validated and support legal recourse in “a partners agreement” instead of the current “employee-employer contract” and that the insurers must be accountable to in court to this new contract?
Simply stated it might read something like this (with 11 pages of legalese from our lawyers that structures the responsibilities and supports the clarity of the following):
- patients come first
- physicians have a right to receive pay for services rendered.
- insurers pay patients according to their contracts, not physicians
- patients pay physicians directly
- patients have the right to decide what they will accept as personal risk in their health and in their financial circumstances.
- insurers may not interfere in any way with the decision making of the patient in concert with the physician.
- insurers may not set pricing restrictions on physicians. They may however set limitations in their service contract with the patient on what they will cover in their contract.
- physicians have the privilege and the right to support their patients in their efforts to obtain quality healthcare delivery and insurance coverage
- physicians have the right to personal privacy and protect patient privacy by only allowing data stripped of unique identifiers to be collected and stored centrally. Centralized charting must not contain any unique identifiers other than the physicians delivery of care office information.
Please add on or discuss as you see fit!
This discussion might lead to some sort of standardized counter offer to insurers since so many physicians are afraid to leave that system which has steadily moved toward indentured servitude.
While IP4PI appreciates the efforts and goals of the Republican Affordable Healthcare act, it is far from the “full repeal” that was promised over the last two election cycles. As independent physicians, we believe that it doesn’t go far enough in repealing the failed ACA, protecting patient choice and permitting the free market to produce excellence, efficiency and economy. We recommend that big money special interests like pharmaceutical industry, hospital industry, health information technology industry and insurance industry not have undue influence in the process as they have for decades but physicians and patients.
1. Full repeal of ACA/Obamacare by reconciliation.
2. True inexpensive high deductible insurance plans competing across state lines for maximum choice, efficiency and economy.
3. Medicaid block granted back to the states where each state can provide flexible solutions for their citizens.
4. Health savings accounts HSA us should be expanded for use for all medical needs so that patients can select any care or items related to health with their own value systems.
5. Primary care and basic specialty care paid directly to physicians by the patients who selected them. Prices to be posted whether per incident or monthly membership model like DPC Direct primary care.
6. Executive, legislative and judicial for branches of government must abide by this law for their own healthcare.
14 Principles for healthcare freedom
Articles critiquing GOP ACA change bill
A friend of IP4PI shares the story of another victim of government and insurance run medicine:
A 40 year old female, patient of mine in a previous practice, returned to me in my DPC practice. Her husband once had a good job and insurance, now with cardiomyopathy, and she is on medicaid. She returned to me with a 1.5 year history of intractable nausea and vomiting. I reviewed 800 pages of records. She had been to the ER 40 times, admitted 20. At 90% of these visits, she was misdiagnosed as having cyclic vomiting syndrome, given IV fluids, Reglan and antiemetics, and sent home. Buried in the 800 pages I found a markedly positive gastric emptying study. She has now been to the Cleveland Clinic, has received the correct treatment for her gastroparesis, and is finally improving. I guessitmate over $300,000 was spent on her (mis)care, when the proper care could have been given for well under 1/3 of that.
A friend of IP4PI shares this real life tragedy:
My good friend’s (deceased) son died in 2015 of MI at age 37, having visited the ER, one hospitalization, and his primary care NP 25 times with symptoms. Although his symptom complaints were by no means classic for coronary disease (that’s why we make the big bucks, right?), they included chest and arm pain, shortness of breath, fatigue, nausea and dizziness. I reviewed 1200 pages of records for the family. After one negative stress test (and a number of other noncardiac negative testing) he was told repeatedly that he was “anxious”, and sent home again and again with a benzodiazepine prescription. At every ER encounter, he was asked such government inspired questions as “Is your spouse abusing you?” (this was a strapping young construction worker), and told at the end of each visit to “return if you have concerning symptoms” (he did, 18 times) but only ONCE did anyone document the fact that his father had an MI in his 30’s !! He had an 8 year old son, whose mother is out of the picture, and a girlfriend of 7 years. They were married on Valentine’s Day, 2015. On March 28, he called the life squad again, telling them “I feel like I’m going to die!!” He was taken to the ED, told again he was anxious, sent home with Rx. On March 30, while making love with his new bride, he had chest pain. Squad called. His widow played the 911 recording for me. As she pleads with them to hurry, he can be heard yelling to them in the background: “I told you there was something wrong!!! I told you!!!!” His last words. Then he vomits and dies. For me, this case could not be more clear. His dad was cared for by unfettered professionals (1980s), who correctly diagnosed and treated him, and he never had another heart problem. 30 years of ‘progress’ later, his son was misdiagnosed and mistreated by “providers” directed by Washington and insurance companies. He is dead, his son orphaned (his widow has now gained custody. Despite whatever risk it might entail to her lawsuit, she is willing to speak publicly about this, in hopes of preventing similar tragedy for others.) Note that U.S. life expectancy fell in 2015, for the first time since the AIDS epidemic.