Independent physicians plan to battle #coronavirus #COVID19, tackle Homeland security and ensure patient freedom and choice

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By Craig M. Wax DO

CORONA VIRUS COVID19 – INDEPENDENT & EMPLOYED PHYSICIANS NEED:

Click here for printable PDF you can send to your Members of Congress.

Independent testing sites and protocols with universal precautions

Guidelines for Medicare and insurance companies to pay for telemedicine (Audio and Video) to screen patients from their homes (Full fee schedule)

1. Temporary regs x 6 months and return to in-person standard of care

  • Eliminate insurance red tape: prior authorizations (Rx) and precertification (procedures)
  • Eliminate insurance networks to allow all physician to aid all patients
  • Support for independent physician practices to remain viable
  • Running a highly regulated business with employed staff in an epidemic
  • Regulatory, legal, contractual, taxes, overhead, need to pay staff despite changing model from in person medicine to audio and video telemedicine
  • Safety for physicians and staff to continue to provide medical care
  • Issue all physicians all protective gear if they are to see patients in their offices
  • Physician direct Rx dispense (only legal in certain states, not NJ, NY,MA, TX…)
  • Eliminating mandatory eRX as it limits physician and patient options.
  • Suspend federal law to allow Medicaid non-par physician to Rx and order tests
  • Suspend MACRA MIPS and all “quality measures”
  • Suspend or eliminate MOC (maintenance of certification) and OCC (Osteopathic Certification) mandates imposed by hospital and insurance companies (currently blocks patient access)
  • Any available physician who completed MD and DO school and two steps of USMLE or NBOME should be eligible to practice.  There’s a population of trained physicians who can’t secure a residency slot due to inadequate number of US slots (Missouri state model). They have more training and experience than NPs and PAs.

HOMELAND SECURITY AND CORONAVIRUS COVID 19

  1. Chinese Government Endangered the World1
  2. COVID 19 cases began November but covered up through end of December
  3. China Rx – China is contractor and subcontractor for most pharmaceuticals,2,3,4

World pharmaceutical, protective equipment and technology supply chain compromised.

             D.  Critical Rx and Supply Shortages 2

              F.  COVID19 potential treatments:  Chloroquine and hydrocycholoquine (Plaquenil)5

                        1. generic and inexpensive

                        2. not FDA approved for COVID19 virus treatment

                        3. no complete controlled studies, beginning use abroad and domestic

                        4. Dosage and indications unclear to get benefit and avoid toxicity

CORONA VIRUS – COVID 19

1https://foreignpolicy.com/2020/02/15/coronavirus-xi-jinping-chinas-incompetence-endangered-the-world/
2,https://thehill.com/policy/healthcare/484276-coronavirus-outbreak-could-cause-shortages-of-150-drugs-report

3China Rx, Gibson, Rosemary

5 https://www.moaa.org/Content/Publications-and-Media/News-Articles/2019-News-Articles/Made-in-China–How-U-S–Dependence-on-Chinese-Medicines-and-Components-Could-Pose-a-Security-Threat

5https://wattsupwiththat.com/2020/03/17/an-effective-treatment-for-coronavirus-covid-19-has-been-found-in-a-common-anti-malarial-drug/

How to Increase Access to Medical Care and Lower the Cost

Through Competition and Choice

A.   Unleash the Power of the Free Market in the Healthcare Sector

  • Expand patients’ freedom and choice in the use of health savings account dollars, especially as payment for direct primary care and other models of coverage, such as periodic-fee, membership subscription services.[1] [2]
  • Codify the use of Association Health Plans (AHPs) and Short-Term Limited Duration Insurance (STLDI) as affordable, portable alternatives to current models of coverage.[3]
  • Allow Medicaid patients to use provided monies as a voucher to purchase periodic fee services.
  • Repeal the “Safe Harbor” protections of 42 U.S.C. 1320a-7b(b)(3)(C) for kickbacks to PBMs and GPOs. [4]
  • Repeal the ACA’s prohibition of physician-owned hospitals.[5]
  • Solve “surprise billing” via the arbitration model already working in New York and Texas. Benchmark rate-setting is tantamount to price controls, an anti-free market mechanism with an abysmal track record.

B.   Repeal Onerous, Unnecessary Mandates

  • Remove Electronic Health Record (EHR) and Merit-Based Incentive Payment System (MIPS) mandates for practices having fewer than 50 physicians.
  • Streamline and reform the prior-authorization requirement in Medicare Advantage and other third-party markets.[6]

C.    Mandate Transparency 

  • Codify the measures in the Administration’s two executive orders on transparency.[7] [8]
  • Direct a study by the GAO of the accounting of PBMs ( already a bill), and eventually the GPOs.[9]
  • Mandate transparency regarding the training of all levels of medical practitioner.[10]
  • Make fully transparent the funding that flows FROM pharmacy “channel companies” (such as PBMs, GPOs, and distributors) TO advocacy groups, physicians, and think tanks. This transparency should be retroactive, so as to establish histories of possible conflicts of interest, as called for on page 33 of the white paper referenced in footnote 4.

Bridge to better healthcare:

Reducing Cost and Waste in American Medicine: A physician-led roadmap

IDEAL HEALTHCARE – Freemarket competition to improve quality, decrease price and provide choice for patients

CBO report shows full Obamacare repeal is better than partial, The Hill

https://thehill.com/blogs/pundits-blog/healthcare/317269-obamacare-cbo-report-shows-full-repeal-is-better-than-partial

We should replace Obamacare with a universal tax credit – Forbes, John Goodman

https://www.forbes.com/sites/johngoodman/2015/04/01/why-we-should-replace-obamacare-with-a-universal-health-tax-credit/#735c226529b5

IP4PI Principles for Individual Choice in Healthcare – Independent Physicians for Patient Independence

https://ip4pi.wordpress.com/2017/01/08/mr-trump-here-are-14-solutions-for-ultimate-citizen-consumer-healthcare-choice/


[1] Rep. Roy’s bill: https://www.congress.gov/bill/116th-congress/house-bill/5596?s=1&r=1

[2] Sen. Cruz’s bill: https://www.congress.gov/bill/116th-congress/senate-bill/3112?s=1&r=5

[3] https://www.whitehouse.gov/presidential-actions/presidential-executive-order-promoting-healthcare-choice-competition-across-united-states/

[4] See Appendix B in the white paper: Reducing Cost and Waste: A Physician-Led Roadmap to Patient-Centered Medical Care for a legislative proposal yet to be introduced.

[5] Sen. Lankford’s bill: “Patient Access to Higher Quality Health Care Act of 2019

[6] Rep. DelBene’s bill: https://www.congress.gov/bill/116th-congress/house-bill/3107

[7] https://www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/

[8] https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html

[9] Rep. Marshall’s bill: https://www.congress.gov/bill/116th-congress/house-bill/3223?q=%7B%22search%22%3A%5B%22hr3223%22%5D%7D&s=1&r=1

[10] Rep. Bucshon’s bill https://www.congress.gov/bill/115th-congress/house-bill/3928/all-info

Insurers going into the drug manufacturing business? Imagine Hershey starting a milk farm.

Friend of IP4PI Bob Campbell, MD writes in:

BCBS announced this week it is planning to become a manufacturer of generic drugs. This bizarre market behavior is a direct result of the anti competitive secret contracts. It is not at all how normal markets work. 

Hershey Foods is based in my town. Let’s say cocoa beans and milk and almonds and sugar were unavailable due to some form of anticompetitive cartel. Hershey might buy land in Africa and start cocoa bean farms and buy land in Brazil and begin growing sugar cane and buy land in Iowa and stock it with dairy cows and buy land in California and plant almond trees. The problem here is they do not have the resources experience and expertise to do this well. They know nothing about almond farms and nothing about African politics and farm workers.

Markets encourage efficient specialization. This lowers cost and improves the value equation for the customer. Free markets enhance supply chain productivity.  Think if Dow chemical had to drill for its own oil to make its plastics and materials. They know nothing about drilling for oil. Bad for Dow and bad for consumers.

Insurance companies last time I checked were not running their industry very well. I pay a $27k per year premium for embarrassingly bad coverage. They should fix their own industry before they become a pharmaceutical manufacturer. This bizarre inefficient market behavior is a predictable outcome with the Safe harbor in place. It is what is called a broken marketplace.

Read the American Antitrust Institute White Paper on the GPO/PBM Safe Harbor. The drug shortages are a predictable outcome. They will persist as long as the safe harbor for racketeering persists. 

Bloomberg just came out in favor of eliminating all PBM kickbacks. He said we will make pharma manufacturers compete again with no payments to PBMs distorting the marketplace. Remember Azar our in a new fixed rate kickback to replace the traditional % of revenue kickback in the Trump PBM Rule. Trump does not want to be seen backing down from his prescription to lower prescription costs plan and he does not want to have a Bloomberg lite watered down plan. Trump should be even more bold than Bloomberg in this issue. 

The ACP Vision: Compulsory Single-Payer System

Comrades,

ACP (or should it be ACCCP) has proposed “a bold new plan,” Vice-Premier of Government Affairs, Bob Ilyich Doherty announced last week. 50+ years of a Cold War on American health care have not yet succeeded in complete elimination of medical freedom..

To finish the job, ACP has released its detailed plan to achieve “universal coverage.” Whether the plan will require sending private physicians to the gulag for re-education to become loyal hospital employee and health plan party members has not yet been disclosed.

AAPS reports on what is in the plan:

“This proposal is a 180-degree shift from the American Medical Association’s stand in 1965, when it proclaimed that ‘The voluntary way is the American way,’” states AAPS executive director Jane M. Orient, M.D. “Reading the actual plan reveals that it is the involuntary way.” She points to key provisions:

  • “The ACP believes that to achieve true universal coverage, coverage must be compulsory.”
  • “Enrollment in any new U.S. system must be mandatory.”
  • “The ACP opposes the sale of duplicative coverage.”

According to ACP senior vice president Robert Doherty, the organization still envisions a limited potential role for private supplemental insurance in its preferred single-payer model. Dr. Orient points out that this means people could get coverage for luxury services like cosmetic surgery but would be restricted to the government-funded plan for life-saving services—as in Canada and in U.S. Medicare for the elderly.

For inevitable cost overruns, ACP supports a global budgeting model: “the process by which society chooses, directs, and enforces how much to spend on health care, what to spend it on, and where that spending will take place.” In Canada, this means that when the budget is exhausted, the operating room closes, Dr. Orient noted.

ACP plans to reduce administrative costs through a government takeover, but Dr. Orient states that Medicare grossly understates administrative costs and shifts them to the private sector. Moreover, the Department of Justice claims that there have been $19 billion in fraudulent Medicare charges since 2007.

The death-panel equivalent is palliative care, observes Dr. Orient. ACP states: “One quarter of Medicare dollars are spent during the last year of a beneficiary’s life…. Palliative care has been shown to reduce costs, particularly in the hospital setting.”

“Patients need to be in control,” Dr. Orient. “They must not put their lives in the hands of government or ACP bureaucrats. They need freedom-based solutions, as outlined in an AAPS white paper.”

Trust: The central issue in health care reform

Marion Mass, M.D. and Craig M. Wax, D.O.

$6.1 million per year represents an increase in 12% of the take home pay that Gene Woods received from public non-profit Atrium Health system last year.  During this 6.1 million dollar year the following remarkable events happened:

 A group of over 80 physicians accused Atrium of monopolistic and anti-competitive behavior and left, starting independent Tyron Medical Partners

Atrium terminated its 40+ year contract with anesthesiologist group Southeast, and replaced them with another.   This move spawned lawsuits now pending in North Carolina Business Court, and spilling into public view.   One Southeast anesthesiologist boldly wrote to the Charlotte mayor, “we think that this decision puts our community members at risk.” The anesthesiologists “believe that the community should know about this, and that they should be able to weigh in on the decision,” the physician wrote.

 In November,Atrium said that personal information for more than 2 million of it patientsmay have been compromised in a data breach of billing information, includingaddresses, dates of birth and Social Security numbers. Oops.

Continue reading

Insurance Networks are a Bug, Not a Feature: Practicing Physicians Ask Senate HELP Committee to Protect Patient and Physician Choice

The Senate HELP Committee, led by Chairman Lamar Alexander and Ranking Member Patty Murray, have asked for feedback on the draft of an ambitious “Lower Healthcare Costs Act of 2019.”

Tuesday, June 4, Practicing Physicians of America (PPA) will present, in Washington DC, a memo co-authored by PPA co-founder Marion Mass, MD and Vice President for Health Policy Craig M. Wax, DO.

The memo begins:

Writing on behalf of Practicing Physicians of America (PPA), we are grateful for and commend the HELP Committee’s efforts to introduce legislation aimed at reducing the varied costs of healthcare services and insurance by increasing the transparency of pricing across this sector of the economy.

It is our position that allowing market competition, with its attendant disciplines and efficiencies, can become the self-sustaining model for the delivery of medical services in the United States. Therefore, with the Lower Healthcare Costs Act of 2019 now under discussion, we offer comments and recommendations beginning on the next page.

Read the full memo at: https://ip4pi.files.wordpress.com/2019/06/ppasenatelhca060319.pdf

Or click on the image below:

Stop the Rush to Legalize Cannabis/Marijuana

Dear Governor Murphy:

I am opposed to the rush to legalize cannabis or marijuana in New Jersey, without research, trials, adequate review of history, and consideration of risk of collateral damage. With the current heroin, fentanyl, opiate crisis, it is foolhardy to rush into legalization of a gateway drug like cannabis or marijuana. At this time the hurry seems to be all about tax revenue, with no concern for the heath and welfare of the citizens of New Jersey.

https://nypost.com/2019/03/19/stop-ignoring-the-brutal-downside-of-legal-pot/

Please feel free to contact me with any questions or for ongoing discussion.

Best wishes for good health,
Craig M. Wax, DO
Family Physician

P.S. Please see below note in agreement from my fellow NJ physician colleague, Dr. Rob Pedowitz.


The Legalization of Marijuana Is All about the Money!

Dear Fellow Physician,

As a concerned physician and NJ Resident, I am writing today to ask for your assistance on defeating a very significant legislative bill, “The Legalization of Recreational Marijuana,” S2703, due for a floor vote on Monday, March 25, 2019 in Trenton.

Regardless of your political affiliation or personal beliefs, the decision by the legislature to move forward quickly with trying to pass this bill without consulting the medical community, or without fully exploring the legal, social, psychological, financial, and medical aspects of this issue may have significant repercussions. We have fought hard the last few years to battle the opioid epidemic, and though marijuana has many benefits for medicinal purposes, there are very little proven benefits when used recreationally. To legalize marijuana and make it readily available to the public, would only provide an easier gateway for people to desire stronger drugs, including prescribed opiates, heroin, and other psychoactive drugs. There are recent reports of other countries and in several states in the U.S. where people who smoke marijuana are now seeking more potent forms of cannabis, which are causing serious psychoactive complications. Treating mental illness has been difficult in NJ and the rest of this country, and if not properly regulated, we can have a worsened mental health crisis. We also may have to deal with worsened air pollution, which is already a problem in NJ as we have very high rates of asthma and other respiratory conditions.

Additional concerns for the medical community include determining evaluating employees and potential new hires for whether they may be under the influence of marijuana. Since the metabolites of marijuana can stay in the body for at least 72 hours, drug tests may be positive, even if a person did not use marijuana on the day of question. However, we may not be able to fully determine whether or not an employee is under the influence or not. Better testing and better guidance is needed for both the medical community and for employers.

Since there is much still to discuss and much more that needs to be decided, we need to defeat this bill. It is imperative that you call your local State Senator AND Assembly Representative today or Friday. There is still a lot of legislators on the fence and the vote can sway one way or the other. From my discussions with numerous legislators, they were very honest and said that this issue is “ONLY ABOUT MONEY.” They were very clear that the decision to pass this bill only comes down to money – taxes and revenue. In addition to contacting your local legislators, I also urge you to contact a few “key” State Senators who are on the fence but leaning to vote against the bill.

Please call:

Declan O’Scanlon (R) – Holmdel, (732)444-1838
Vin Gopal (D) – Freehold/Ocean/Tinton Falls, (732)695-3371
Paul Sarlo (D) – Passaic, Wood-Ridge, (201)804-8118
Joseph Lagana (D) – Paramus, (201)576-9199

You do not need to have a political background to contact a legislator. Just look up their contact information and call them up. Tell them who you are and that you are a physician, and if you are in their voting district (this matters A LOT!). Please do NOT state you represent any organization or hospital or group, as this will not be helpful or necessarily accurate.

Please contact me individually if you have any questions.

Thank you for your assistance on this vital issue!

Sincerely,

Rob Pedowitz, DO

Physicians: See the movie that hospitals don’t want you to see

SNEAK PREVIEW!

Do No Harm: physician suicide documentary

Angelika Film Center
18 Houston Street New York City
Wednesday September 12th 7:00pm
Thursday September 13th 7:00pm

In honor of Suicide Awareness Month- a special medical community SNEAK PREVIEW screening of the groundbreaking documentary film “Do No Harm.” Two time Emmy winning filmmaker Robyn Symon follows four people bonded by tragedy on a mission to expose a toxic medical culture beginning in medical school that puts the lives of doctors and patients at risk.

2 NIGHTS ONLY.

JOIN US LIVE: For a panel discussion following the movie with filmmaker Robyn Symon and stars Dr. Pamela Wible, John and Michele Dietl and others.

Password for tickets: DNH

https://www.eventbrite.com/e/do-no-harm-documentary-film-about-the-hidden-epidemic-of-physician-suicide-tickets-48224914016

Confusion Clouds HHS Cybersecurity Plans

Today’s article about HHS cybersecurity planning, published in Becker’s Hospital Review, reports on a yet another policy failure courtesy of the bloated bureaucracy in DC. The federal government is so big that it doesn’t know what departments it has or how it’s spent our money.

In April 2017 HHS announced the planned formation of a Healthcare Cybersecurity and Communications Integration Center (HCCIC). 14 months later, you’d expect that the HCCIC would be off an running, especially given the massive patient data breeches and ransomware attacks that have become all too common. Wrong. Instead massive confusion surrounds the status on the HCCIC. Congress is looking for answers and HHS seems to have few answers.

One telling quote from Becker’s:

Stakeholders have informed our staffs that they no longer understand whether the HCCIC still exists, who is running it or what capabilities and responsibilities it has,” the lawmakers wrote, noting HHS has provided only vague responses to requests for clarification on these issues.

Mix in to this milieu the fact that there are already existing government agencies tasked with similar responsibilities. Government inefficiently at its worst.

Read more at:

https://www.beckershospitalreview.com/cybersecurity/congressional-leaders-to-hhs-it-s-unclear-if-troubled-cybersecurity-center-still-exists.html

“Continuing Board Certification” sounds swell but harms patients.

Dr. Walter Wood writes:

I board certified prior to 1991 and have “lifetime” certification equivalent to an academic degree. I can attest that my younger colleagues and their patients are being harmed by costly and time consuming “requirements” to participate in “re-certification” and “maintenance” of certification, soon to be renamed “Continuing Board Certification,” which is not needed and not only does not help patients but harms them. Patients in need are harmed when a doctor is not taking care of patients because the doctor is busy preparing for or repeatedly jumping through hoops such as what lawyers experience once in a lifetime with their bar exam. I was somewhat stunned that an anti-trust judge thought it was necessary to demonstrate “harm to consumers” as a result of the egregious behavior of the ABMS and its colluding member boards. That judge needs to be asked whether s/he repeats the bar exam every ten years.

Walter Wood, MD, FAAD

P.S. I have posted these comments at certificationharm.org.