DAY IN DC FOR THE GOOD OF PATIENTS-empowering physicians to put patients first.

In the Oath of Hippocrates, physicians promise to work for the good of their patients, according to the best of their ability and judgment, and to do no harm. We support a return to this ethic in American medicine, and oppose policies that harm patients by subjugating care to the interest of the government and third parties.

Reform Issues:

  • Overregulation and mandates restrict access, stifle innovation, impede transparency, block competition & raise costs.
  • Fraud, waste, and shortages are rampant because special favors to middlemen.
  • Employer-based and government-run insurance discourages rational insurance practices.
  • Medicare and Medicaid are bankrupting the federal government, states, and doctors.
  • In the era of COVID, the consequences of usurping of patient and physician autonomy and freedoms are becoming increasingly apparent and dangerous.

Proposed Solutions: to protect freedom, increase options, encourage competition, and unwind unsustainable spending.

  1. End mask, vaccine, and other mandates and policies that intrude on patient autonomy. This also includes protecting Americans from World Health Organization policies that too often become mandates.
  2. Protect physician and patient freedom of speech in all venues, including the Internet. The government and media must not limit legal speech and must be transparent about their sources of funding and control. (See Texas HB 20.)
  3. Protect physician and patient autonomy in treatment and vaccination decisions. Early treatment for COVID saves lives and should not be improperly blocked by government or other bureaucrats. See AZ SB 1416 and MO HB 2149). Vaccine mandates are hurting vulnerable patients at low risk for COVID and must end. (See FL HB 1B, 3B, 5B, 7B).
  4. Protect due process rights of physicians who too often face retaliation, simply for advocating for patients, by employers, hospital administrators, licensing boards, and others who control their ability to practice. Needed reforms include repealing HCQIA’s qualified immunity for sham peer review, reform of the National Practitioner Databank, and rights for physicians employed by private equity controlled corporations.
  5. Work toward independence from China CCP medications, tech, manufacturing, goods and WHO influence.
  6. End regulations blocking alternatives to ACA, employment-based, Medicare, and Medicaid plans, while allowing those who wish to keep their current government plan to do so.
  7. End ACA’s ban on physician owned hospitals. Section 6001 of the Affordable Care Act of amended section 1877 of the Social Security Act to generally prohibited those who know best how to care for patients from running the facilities where care for the most seriously ill and injured often takes place.
  8. Encourage transparency. Health care entities receiving taxpayer-subsidized funds from any source must disclose all prices that are accepted as payment in full for products and services furnished to individual consumers. Transparency by agencies (FDA, CDC, NIH, etc.) that control and influence health policy and treatment guidelines is also paramount. Transparency in training, so that patients know the qualifications of the clinicians caring for them, is also needed as patients are increasingly pushed to obtain care from individuals with significantly less training than physicians. Databases disclosing potential conflicts of interest must include all entities receiving or offering payments (e.g. device and pharmaceutical manufacturers, PBMs, GPOs, hospitals, insurers) not just physicians.
  9. Remove legal protection for kickbacks. Remedy GPO and PBM abuse of safe harbors by encouraging Congress to repeal 42 U.S.C. § 1320a-7b(b)(3)(C) and amplifying HHS-OIG efforts to stop exploitation of 42 C.F.R. § 1001.952(j) and related regulations. Ending kickbacks is a crucial aspect of ending America’s reliance on China for drugs and supplies.
  10. Decouple Social Security benefits from Medicare Part A. Citizens should be permitted to disenroll from Medicare Part A without forgoing Social Security payments. This would immediately decrease government spending and open the potential for a true insurance market for the over-65 population.
  11. Repeal Medicaid rules that decrease Medicaid patients’ access to independent physicians. ACA requires physicians ordering and prescribing for Medicaid patients to be enrolled in Medicaid. This creates barriers for Medicaid patients who seek care from independent physicians but wish to use Medicaid benefits for prescriptions, diagnostics, and hospital fees. This is a particular problem for Medicaid patients seeking treatment for opioid addiction.
  12. Explicitly define direct patient care (DPC) agreements as medical care (instead of insurance) so patients can use their HSAs, HRAs and FSAs for DPC.
  13. Expand Health Savings Accounts (HSAs).  Examples of needed reform include repealing the requirement that an individual making a tax-deductible contribution to an HSA be covered by a high deductible health care plan; increasing the maximum HSA contribution level; allowing Medicare eligible individuals to contribute to an HSA. HSA reform will help end tax discrimination. Individual’s payments for medical care should not be taxed differently than payments made by employers.
  14. End Restrictions on Health Sharing Ministries. Open the door for secular charitable sharing plans. Health Care Sharing Plans engage in voluntary sharing and are not a contractual transfer of risk.
  15. Encourage indemnity insurance and competition instead of managed care HMO plans. No limited networks of physicians and facilities.
  16. Address shortcomings of the No Surprises Act, that unfairly increase insurance company control over the ability of patients’ to access care from the physicians of their choice on mutually agreeable terms and that increase red tape for physicians.
  17. Increase options for addressing pre-existing conditions. Invigoration of competition, by implementing the above changes, would bring a variety of products for patients with pre-existing conditions, including reinsurance, and inexpensive guaranteed issue and renewability protections, and most importantly, lower overall cost of care.

Conclusion: Congress has passed law after law that disrupts the patient-physician relationship, corrupts medical decision making, and increases costs. During the COVID era, overregulation and regulatory capture is a greater threat to our nation than ever.   Harmful laws and policies cannot be fixed by adding new regulatory burdens or further usurping patient and physician autonomy. True reform starts with repealing laws and correcting errors, restoring the freedom, under constitutionally limited government, that made America great.

CDC Incompetence on Coronavirus is Symptomatic of Chronic #BigGovernment DC Swamp

Will the CDC come through for Americans as we face the spread of the Coronavirus? Unfortunately the agency’s performance in these first crucial months is looking anything but competent.

https://www.technologyreview.com/s/615323/why-the-cdc-botched-its-coronavirus-testing/

For “our safety” private labs were initially prohibited by the FDA from testing using their own tests:

The result: while private labs’ hands were tied, the tests the CDC rolled out—the only tests available by government fiat—failed.

After long weeks of delays, the FDA finally freed American innovators to go to work:

Is this President Trump’s fault? Not hardly. His attempts to drain the swamp have been attacked at every turn. While he’s succeeded in many ways, notwithstanding the adverse opposition, the CDC remains firmly controlled by “business as usual” establishment bureaucrats.

The agency has a long history of waste:

Back in 2014 Freedom Works asked the telling question, “Why Does Congress Shower The CDC With Money Despite A Track Record Of Waste and Mission Failure.” While spending lavishly on new headquarters that included a Japanese garden, the CDC was “failing to meet its goals for combating infectious diseases.”

https://www.freedomworks.org/content/why-does-congress-shower-cdc-money-despite-track-record-waste-and-mission-failure

The author’s also highlighted findings from a report that highlighted 15 ways the CDC and NIH wasted $15 Billion dollars of taxpayer funds, on projects like telling Americans how to eat, and funds for Gay activists in public schools

https://www.newsbusters.org/blogs/joseph-rossell/2014/10/16/hey-journalists-15-ways-nih-and-cdc-wasted-taxpayer-money

Another priority for the CDC is apparently making sure teens have condoms.

The hard truth is that the CDC “is a highly politicized organization.”

After dropping the ball on testing, instead of refocusing and making sure it has a laser focus on the problem at hand, the CDC is moving full speed ahead on spending the money Nancy Pelosi insisted on hiding in the “must pass” spending bill passed in December to avoid a government shutdown.

What is the cure for swamp fever? More freedom for our highly competent innovators. Americans cannot depend on entrenched federal bureaucrats. Hopefully the American private sector can once again come to the rescue as they have many times in the past, if DC will let them.

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

Call Your NJ Politicians Now to Vote NO on S4204! Physicians (and everyone else) in NJ will be unable to take side jobs as contractors.

“New Jersey’s law regarding independent contractors [will be] the most restrictive in the nation,” if the State Legislature passes S4204, reports JD Supra in an analysis of a ill-conceived bill ” that could decimate the state’s gig economy.”

The Jersey Conservative puts it this way:

Are you a photographer? A truck driver owner-operator? A freelance writer? A tree trimmer? A dog groomer? A lawyer? A locksmith? A tow-truck driver? A million other things? [e.g. a doctor] Yeah. You’re screwed.

https://www.jerseyconservative.org/blog/2019/11/22/trentonian-the-lives-of-hundreds-of-thousands-of-new-jerseyans-are-about-to-be-destroyed

Spurred by the growth of crowdsourcing apps like Uber and Lyft, this bill “could effectively end independent contract work for many residents in the state if passed,” concurs the Washington Examiner.

California passed a similarly controversial bill earlier this year. But unlike the California bill that exempted a broad array of professionals, including physicians and surgeons, from the law’s prohibition on independent contracting, the NJ bill has only very narrow exemptions.

As written, under the New Jersey bill, “doctors who contract with a health care group, an attorney contracted by a law firm or a political consultant contracted to a political campaign may not be able to [be considered an independent contractor],” concludes JD Supra.

Can such a draconian and un-American bill pass? It is being “fast-tracked for passage in the coming weeks,” according to the Jersey Conservative blog. And JD Supra “predict[s] it will [pass].”

Please speak out TODAY and ask your NJ legislators to oppose S4204: https://www.njleg.state.nj.us/SelectMun.asp

Read more about the implications of this awful bill: https://www.jerseyconservative.org/blog/2019/11/22/trentonian-the-lives-of-hundreds-of-thousands-of-new-jerseyans-are-about-to-be-destroyed

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 


Is New York’s “Surprise Bill” Law a Model for Federal Legislation? Yes and No.

There’s a big fight brewing in DC. No, not the one between the “Squad” and President Trump, which will likely be forgotten as soon as the outrage addicts need a new fix. The fight we’re talking about will have a much greater impact on Americans and is occuring between insurers and hospitals over various proposals to combat “surprise bills.”

The bottom line: as these behemoths clash, patients and physicians — those who need medical care, and those who deliver it — are set to be further marginalized.


We interrupt this blog post for a quick, but important, Action Alert: The bill furthest along at the moment is the Senate HELP bill, S 1895, which is now eligible for a vote on the Senate floor after passing through committee on July 8. A favorable (but unrealistic) CBO score has also been issued, increasing its chances for a vote. CALL BOTH OF YOUR U.S. SENATORS and tell them to VOTE NO on S 1895 if it comes up for a vote. The fastest way to reach your Senators is by calling the Capitol Switchboard at (202) 224-3121.


A review of the the major problems with S 1895, and others like it, can be found here, here, here, and here. S 1895, while containing potentially a few helpful provisions, is for the most part, putting band-aids on top of existing failed cancerous policies — band-aids that will exacerbate the disease instead of excising the tumor causing it. Not to mention that insurance-company controlled “unsurprise bills” may be a significantly bigger problem than surprise bills, as disintermediator Dave Chase explains. In addition the bill imposes system-wide rules to address a problem that is not as widespread as advertised. “The cost of surprise bills is a small portion of all health care spending…,” reports the CBO in its score of the bill.

In the physician community, some are suggesting that legislation like S 1895 would be acceptable if arbitration provisions are included. There is also a suggestion that a competing bill over on the House side, HR 3502 (Ruiz/Roe) is the compromise bill that can be supported, because it includes an arbitration option, and is modeled after New York’s heralded surprise billing regulations. [Update: similar arbitration provisions have now also been added to the House E&C legislation (HR 3630) addressing surprise bills.]

As state regulation of market transactions go, NY’s surprise billing law seems to cut a reasonable path. It prohibits abuses by hospitals without swinging the pendulum too far in favor of insurers. It permits a reasonable level of flexibility for patients and physicians to interact on mutually agreeable terms.

But does HR 3502 really mirror NY statue? Both do allow for arbitration, but aside from that the similarities meaningfully end.

Here are some key differences:

1) The NY law kicks in only with charges above 120% of the Usual and Customary, defined to mean “the eightieth percentile of all charges for the particular health care service.” That’s a pretty high bar that helps contain overregulation.
https://www.nysenate.gov/legislation/laws/FIS/602
https://www.nysenate.gov/legislation/laws/FIS/603

Conversely, HR3502 sets a benchmark price at “the commercially reasonable rate, as determined by the plan or issuer.” That is drastically one-sided in favor of insurers and likely unconstitutional, argues a former U.S. Solicitor General.

Yes arbitration may help provide relief from this extreme price setting to hospitals, and health systems, and “Wall Street-owned doctor groups” who can afford the expense, but arbitration is not a meaningful option for small or independent practices in many cases. 

2) Also the NY law defines “Surprise Bill” in a way that allows patients and physicians some ability to voluntarily opt out of limitations, if both parties desire, i.e.: “a surprise bill shall not mean a bill received for health care services when a participating physician is available and the insured has elected to obtain services from a non-participating physician….” And under the NY law, patients have to take an affirmative step to trigger a prohibition on balance billing: ” When an insured assigns benefits for a surprise bill in writing to a non-participating physician that knows the insured is insured under a health care plan, the non-participating physician shall not bill the insured except for any applicable copayment, coinsurance or deductible that would be owed if the insured utilized a participating physician.” https://www.nysenate.gov/legislation/laws/FIS/608

HR 3502, on the other hand, makes no provisions for patients and physicians voluntarily opting out of the provisions of the legislation, and in fact levies fines and penalties on physicians who don’t comply: “if such nonparticipating provider holds such individual liable for a payment amount for such an item or service furnished by such provider that is more than the cost-sharing amount for such item or service … such provider shall be subject … to a civil money penalty of not more than an amount determined appropriate by the Secretary for each specified claim.
https://www.congress.gov/bill/116th-congress/house-bill/3502/text

So back to the question posed in the title of this post, is the NY surprise billing law a model for federal legislation? If it were actually being followed as a model, the answer might be “yes.” But given the existing bills on the table in DC, the answer is “no.” NY law is being followed as a model in name only, not in practice.

Ultimately, the phenomenon of surprise bills signals a more fundamental problem: past failed policies that tilt the playing field in favor third party payment and punish direct payment limit patient options and are impeding market forces from squeezing out costs that line the pockets of administrators and middlemen who add minimal or no value. It is past time to level the playing field and unleash innovations that will allow those who care for patients the freedom provide an abundance of lower cost, high-quality options.

Dear CNBC, Please do your research before you comment…

Dear CNBC, please be advised that before you criticize anything, you should do your research. The unaffordable careless act, known as ACA Obamacare, has changed the entire field of health insurance to few government approved and some Medicaid subsidy plans. More than half the exchange insurance co-ops started with taxpayer dollars are now bankrupt.  Most private insurers have left Obamacare exchanges leaving monopolies or even threaten to leave no insurers present to prevent citizens from being fined by the IRS for not buying nonexistent policies(see stats below). 

ACA Obamacare has trashed the whole industry and taken competition out of the equation, leaving only high prices and poor coverage. Let me know if you need anything further.

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Media host

National Physicians Council on Healthcare Policy member

—————————
Original post:

Trump trips up as he trashes Obamacare

Dan Mangan, CNBC

http://www.cnbc.com/2016/10/25/trump-says-his-workers-having-tremendous-problems-with-obamacare.html

In 6 Charts, the Rising Costs of Obamacare Rates

Educating Legislators about Dangers of Interstate Medical Licensure Compact

Is your state considering entering the Interstate Medical Licensure Compact?  Educate your legislators about why this is a bad idea. Below is a sample letter you can use to assist your outreach efforts.  Even if your state isn’t yet a target start educating your legislators and colleagues today!

Dear Members of the Colorado House of Representatives,

Thank you for your dedicated service to the citizens of Colorado.

We are writing to voice concerns about HB 16-1047 which, if passed, will sign Colorado on to the Interstate Medical Licensure Compact. The Interstate Medical Licensure Compact “may seem like a positive step” at first glance, warns CATO adjunct scholar Shirley Svorny, PhD.  She continues, “[t]he compact is being promoted, disingenuously, as addressing license portability and access to interstate telemedicine…. Adding the Compact Commission creates another layer of bureaucracy and costs.”

States that are closely looking at the Compact are increasingly rejecting it and exploring other state-controlled policy options to better accomplish the goal of license portability. Continue reading

Setting the Record Straight on Horizon BCBS

Dr. Wax writes NJ.com columnist Susan Livio  in repsonse to her February 16, 2106 article, “See why Horizon paid $3M in bonuses to N.J. doctors.” 

Dear Ms. Livio

Your article on Horizon insurance’s program to incentivize physicians was not a balanced view of the program or company.  It also misrepresented the so-called “affordable care act.” Neither entity has done anything to bring down the high cost of health insurance but to force Americans to buy it from profiteering high overhead entities under penalty of law.

Horizon Blue Cross Blue Shield of New Jersey is notoriously one of the most difficult insurance companies to deal with. Their denial rates for payment, denial rates for medications and tests, and poor communications skills are just a few of their issues. Both their patient and “provider” help desks are located off shore in the Philippines or India, despite their massive holdings in the state of New Jersey. One must not forget their bankruptcy in the 1990s, where they were forced to change their company from New Jersey Blue Cross Blue Shield to “Horizon.”  Continue reading

$23 Million Hospital Propaganda Against Doctors

Guest Post from Gene Uzawa Dorio, M.D.

When well-educated medical professionals have no voice, and hospital administrators control public relations, swaying opinions can be harmful to patient care.

Below is my recent posting revealing intentional finger pointing away from the true cause of poor healthcare in our country. It is nationwide, and should be examined in your community.

Thank you for listening.

Gene

$23 Million Hospital Propaganda Against Doctors

On occasion, I feel compelled to put in my two cents at Santa Clarita City Council meetings. Recently there was a five hour meeting about whether the city should subsidize the artsy Laemmle theatre as an anchor to revitalize business in Old Town Newhall.

This is what I said:

As a physician, my job is to weigh risks and benefits.

Advancing technology and research has improved my ability to practice medicine. We don’t give children cough syrup laced with morphine or heroin anymore. Blood letting has been discontinued. Lobotomies are now only reserved for Washington D.C. politicians. Continue reading