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!

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.

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

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?

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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.