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.

The Uncertainty of the Path Ahead

By Katarina Lindley, D.O.

This past year has brought up many issues head on. The fear of the pandemic has changed the way this country has been governed for many years.  As we enter the ballot box next week the choice is clear.  One vote is for liberal, progressive, socialism driven agenda that will bring us closer to the government lead society and the other is for liberty and freedom of a nation that was born from an idea that all men are created equal and deserve success and happiness.

I grew up in a small Balkan country, relatively happy child who did not really understand the dynamics of the life we lived, until I was told not to tell people we went to church because it could cost my dad his job.  It took me many years to realize that Yugoslavia was not the utopian society we were lead to believe and ultimately fear, as all actions were controlled by the government and the freedom of thought was highly discouraged.  I “credit” the socialized medicine with the death of my mother many years ago due to bureaucratic lead healthcare system where ultimately patient is just a number on an endless list of cases and diseases.

This past year has shown me that even a country as free as USA is not free from the attacks within.  The idea of socialism that Bernie Sanders has successfully infiltrated in the halls of our nation capitol has spread within the ranks of Democratic party and its progressive leaders.  The system of government that liberals are trying to push on us is based on an ideology with the ultimate goal of eliminating private property and redistribution of wealth. They are interested in government-controlled education, healthcare and labor, central banking system, as well as the government ownership of transportation and agriculture, making us more dependent on them.  As a physician I believe that Biden’s private option is a socialized takeover of our biggest economical entity which will bring us closer to national socialism.  What many people are not aware of is that socialism does not live in a vacuum and is an extension of communism which many immigrants as myself have fled from.

Watching unrests, riots, attacks on Pro-Trump voters, Jewish Trump caravan and blatant hate of anyone who disagrees with liberal agenda, has given me some flashbacks.  One of my favorite subjects has always been history, and as I was seeing Minneapolis, L.A and closer to home, Austin, defund or decrease police budgets, I remembered studying about Hitler.  In 1933 he ordered “nazification” of the police force by changing the organizational structure, leadership, training and the values of German’s police force. As some view toppling of this nations monuments as an outcry to injustice of Confederate leaders, I view this as a monumental error in trying to erase the history that shaped this nation.  I do not want to forget Stalin or his persecution of Christians and political enemies, or Aushwitz where many Jews where killed because Hitler deemed then inferior.  Few years ago, I visited Tiananmen square and standing there seeing a huge Chinese flag across from it, all I could remember is many lives lost.  History has its placed and should not be forgotten.

This election has become a referendum of the beliefs and values that United States was founded on.  As an immigrant like many others that fled communist regimes, USA is a beacon of hope.  USA is not just a nation but an idea where life, liberty and pursue of happiness are not ideals but a reality; a place where the American dream is alive or it used to be.   My fear for my children is that we will forget, forget 1776, wars fought, 9/11, lives lost.  A nation that does not remember its failures and its wins can never be a free nation.

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.

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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 

I signed! American Academy of Family Physicians: Urge the AAFP to cease their support of HR3708 – Sign the Petition! https://t.co/1BMoG5SwVD via @Change

— AtlasMD (@AtlasMD) October 24, 2019

The New Jersey #APN Bill is back… please call your #legislators and tell them you oppose the S-1961/A854 Bill TODAY!

Dear friends of IP4PI,

Please read this important alert from the NJ Association of Osteopathic Physicians and Surgeons and TAKE ACTION!

CLICK HERE TO READ ALERT ONLINE

Independent Practice for APN’s “Consumer Access to Healthcare” **Call your Legislators now! – Request that they Oppose S-1961/A854 if posted for a vote**
New Jersey’s Current APN Scope of Practice

In New Jersey APNs are currently required to work in “collaboration” with a licensed physician. Collaboration is the ongoing process by which an APN and a physician engage in practice, consistent with agreed upon parameters. APNs must have a written joint protocol with their collaborating physician in order to prescribe medications and devices. An APNs ability to write prescriptions was a “legislative privilege” and therefore some protections, including the joint protocol with a physician, were put in place. Joint protocols can be as expansive or narrow as the parties agree; and typically is very personal to the experience of the APN and their working relationship with the collaborating physician. There are also NJDHSS regulations addressing the time period required for the collaborating physician’s review of a patient’s’ chart and records when seen by an APN. All of these safeguards will go away under this legislative proposal. 

Other State’s APN Practice Requirements

According to the American Academy of Nurse Practitioners, only 22 states allow APNs to practice completely independent of any physician involvement. These states tend to be more rural states (Alaska, Oregon, Washington, Idaho, Montana, North Dakota, Wyoming, Arizona, New Mexico, Iowa, Hawaii, and Colorado) with the only Northeastern states being Vermont, New Hampshire, Maine and Rhode Island. None of New Jersey’s neighboring states or states similarly situated geographically or demographically permit the independent practice of APNs. For more information, please access the following resources:

• White paper prepared by the Coalition
• Document of Bill
• If you do not know your legislators, go to: https://www.njleg.state.nj.us/members/legsearch.asp

Time to Educate the Public on the Difference Between Physician Extenders and Physicians

NJ Physicians Mark Nemiroff, MD, George Petruncio, MD and IP4PI’s Craig M Wax, DO say the difference matters and believe it is time that the public knows the risks of having non-doctors imply that they have the same qualifications as physicians.

They have introduced Resolution 6-2019 at the Medical Society of New Jersey House of Delegates:

Title: Investigation of the autonomous practice of physician extenders in New Jersey and education of the public regarding the differences between physician extenders and physicians.

Sponsored by: Camden County Medical Society

Whereas, physician assistants (PAs) and nurse practitioners (NPs) in the State of New Jersey must have supervising physicians; and

Whereas, there appear to be PAs and NPs practicing semi-autonomously or autonomously in New Jersey with practice names implying they are “Certified Physicians,” and

Where as, physician extender and mid-level practitioner advertisements appear to fraudulently indicate medical licensure, putting public health at risk, and therefore be it

Resolved, the Medical Society of New Jersey call on the New Jersey licensure and regulatory agencies to investigate the legitimacy, guidelines and regulations pertaining to physician extender advertisements and autonomous practice, and be it further

Resolved, the Medical Society of New Jersey educate the public on the difference in education, ability and licensure requirements of physician extenders versus physicians.

Submitted by:

Dr. Mark Nemiroff, President Camden County Medical Society

Dr. George Petruncio

Dr. Craig M. Wax

Be There! New Jersey Doctor-Patient Alliance Inaugural Summit

You will not want to miss this summit on February 8-9, 2019!

IP4PI’s own Craig M. Wax, D.O. will join an all star lineup as a featured speaker. Dr. Wax will share reform priorities that will help put doctors and patients back in the driver’s seat. It is time to put and end to the shenanigans politicians pull to hand advantages to their crony buddies in the hospital industrial complex. Patients and their physicians must team up to reclaim their rights, increase the availability, and slash the cost of high quality care.

Rowan Univ. School of Osteopathic Medicine Remembers Dr. Robert Maurer’s 39 Years of Service

Dear Faculty, Staff, Residents, and Students,

With sadness, we share the news of the passing of Dr. Robert Maurer on September 11, 2016.

Dr. Maurer served as a faculty member in the Department of Family Medicine with the School of Osteopathic Medicine (SOM) for 39 years. During his time of service, he held a number of administrative and clinical roles. He retired from active employment at SOM in 1997, but continued in a volunteer role as an adjunct associate professor until his passing.

R.I.P. Dr. Robert Maurer – a gentleman, a statesman, a renaissance man of Osteopathic medicine

Colleagues,

It is with a sad heart that I write to inform you that my longtime mentor, personal friend and friend to the Osteopathic profession passed away yesterday evening. Robert “Bob” Maurer DO died after a prolonged battle with cancer over the last few years. He was a gentleman, a statesman, and an osteopathic physician, through and through. He brought a kind, commonsense approach to his patient care and the professions fight for recognition and excellence. He was a PCOM graduate 1962, practiced family medicine and rheumatology, and was part of the team that established the school of osteopathic medicine at UMDNJ that became Rowan SOM. He worked for the school in the Department of family practice and established the Sicklerville healthcare center. In his career of that spanned more than four decades, he was a champion of the philosophy and politics of osteopathic physicians and their patients, tirelessly, until his final day. He spoke truth firmly to power, which is virtually unheard of nowadays.

He was described by his longtime friend Albert Talone DO:

“Dr. Bob was the most dedicated man to the profession, I know. His intellect, leadership and integrity were a rarity these days. I will surely miss him   We have truly lost a good friend; a renaissance man of Osteopathic medicine and letters.”

The funeral will be at Temple Emanuel, 100 James Street, Edison, NJ 08820 at 12:30 pm on Thursday.

Internment Beth Israel cemetery 2:15pm.

An In Memoriam from NJAOPS includes more info about Dr. Maurers accomplished lifetime of service:

Born in Brooklyn, he completed his undergraduate education at the University of Pennsylvania in 1953 and received his doctor of osteopathic medicine at the Philadelphia College of Osteopathic Medicine in 1962. Between degrees, he served in the U.S. Navy from 1953-1958.

Dr. Maurer joined NJAOPS in 1963, and served as the 1976-1977 president. He also served the osteopathic profession as a long-time officer of the Middlesex County Osteopathic Society, the NJAOPS House of Delegates, the AOA House of Delegates and the New Jersey Osteopathic Foundation. He was recognized for his contributions as the NJAOPS 1990 Physician of the Year and Life Membership in 2002.

An outspoken advocate for osteopathic physicians and their patients, he ran for the New Jersey Senate in 1983 and the New Jersey General Assembly in 1987.

Beyond New Jersey, in 1970 he became the youngest member ever elected to the PCOM alumni board, provided long-time leadership to the American Osteopathic College of Rheumatology, and secured financial support for osteopathic medical school scholarships and continuing education as a member of the Area VII Physicians Review Organization.

Continuing his advocacy on behalf of his colleagues long after his retirement from practicing medicine, Dr. Maurer has spent the last several years pressing for a reevaluation and reform of physician evaluation and testing unless it can be proven to improve patient care.

Best wishes for good health,
Craig M. Wax, DO
Family Physician
National Physicians Council on Healthcare Policy member
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS
Twitter @drcraigwax

AROC conference spring 2016. (above)
Craig M Wax DO, Robert Maurer DO, Albert Tallone DO

 

California Bill is Bad for Everyone But Insurers

California’s legislature just gave a gift to the insurance and managed care industry and it’s bad news for independent physicians and their patients.

AB 72 is on the way to Governor Jerry Brown’s desk. This bill will not fix the surprise medical bill problem it claims to solve and it will harm patients’ access to medical care by independent physicians.  Insurers will in many cases be able to dictate the fees of out-of-network physicians and the result could be devastating for these doctors.

Doctors in California have sent an emergency request to Governor Brown, asking him to veto this bad bill. It reads in part:

Promoted misleadingly as a means to end ‘surprise billing,’ AB 72 will actually enrich insurance companies while creating shortages of care for patients. Patients are increasingly being forced into narrow networks, in order to cut costs for insurers. The care they need is often not available in the network. Many physicians stay out of network because the extremely low in-network fees they are allowed to charge wouldn’t cover the costs of keeping their doors open…. [T]his bill will exacerbate California’s current physician shortage. Hospital call panels that provide emergency and also safety-net care for uninsured and under-insured Medi-Cal patients will be unable to deliver adequate specialty services.