Playing Healthcare Russian Roulette.

Cynthia Stamer, JD writes in: 

At the heart of this problem is the perception that anyone other than a doctor should be the medical home. All the data and statistics in the world cannot replace the knowledge that comes when a physician knows a patient. The distraction of the patient physician relationship not only is a huge driver in the loss of quality care and increase of cost it is also at the heart of some of the most significant maladies we currently face such as opiate dependence see in mental health challenges. Until we make the doctor the medical home and restore some continuity to the physician patient relationship we will still be playing healthcare Russian roulette.

MIPS Math: a losing equation for physicians and patients

Dr. Jane L. Hughes reacts to the latest offer for MIPS “training”: http://conta.cc/2ps7YTq

I will bet that in their course they will not mention that “the physician must [participate in MIPS]” is not true. The physician chooses to comply in the hope of getting that 9% increase in Medicare payment. CMS says 47% of physicians will lose the zero sum game of MIPS. Weill Cornel Medical college estimates the cost of compliance with EMR, PQRS, etc to be $40,000/physician/year. As I’ve said before, do the math. You would have to clear $430,000 at a 9% return (if you are in the elite compliers) to reimburse yourself for your compliance costs. Hey, then you’d be rolling in reward money…What a thinly veiled process to gather the data to justify real time treatment dictates. I know of no other profession that would give up their privileged communication without a tooth and nail, knock down drag out fight, except the medical profession. If only because of the disastrous treatment implications of not being able to candidly talk and privately record medical and surgical encounters, it would seem to me that all physicians, in spite of the many compliance courses, should choose to just say no, at least to “interoperable EMR with 24/7 unfettered access” by HHS and CMS, as dictated in the MACRA law.

Best regards,

Jane

ACA: enabling sellout of America to the insurance, health IT and hospital industries

Congressman Meadows:

We all need to be opted out as taxpayers, patients and physicians with a full repeal. The Republican Party and congressmen outside of the Freedom Caucus are enabling the liberal Democrat sellout of America by ACA to the insurance, health IT and hospital industries. Unless there is a repeal of all of the limitations on insurance, insurance company bail outs, propped up phony exchanges, and the largest tax increases in the history of our country, we are sunk as a country.

We have solutions from the few remaining private practice physicians who are also taxpayers, parents, and community leaders. We can help you and President Trump keep your words and benefit all Americans while saving everyone money. Please inquire!

Principles for individual citizen healthcare freedom | IP4PI – Independent Physicians for Patient independence:
https://ip4pi.wordpress.com/2017/01/08/mr-trump-here-are-14-solutions-for-ultimate-citizen-consumer-healthcare-choice/

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

A Conversation: Can Free Markets Save American Medicine?

A recent article from the Mises Institute. “Under Socialized Medicine, The State Owns You,” sparked a conversation between Mr. Bob Wells and IP4PI founder Dr. Craig M. Wax.

Bob

I appreciate your assessment of the solutions presented like VA, Medicare and Medicaid being awkward, too expensive, and failing in large demonstrable ways. We haven’t had true market based medicine since World War II. Prior to that, it was relatively inexpensive cash and Barter based services. I argue this is the most efficient as it cuts out insurance, pharmacy benefits managers, all levels of administration, and last but not least, all aspects of government regulation compliance and taxation.

In the last six years there have been at least 12 plans on the table to repeal Obamacare. And, there have been six in the last 12 months. There was no sparsity of plans, just no palpable consensus.

I assert that inexpensive primary care, labs, low-end studies, cheap generic medications, will allow for most needs to be met by most people. And expanded health savings account HSA would be used for each citizen to use pretax dollars to buy anything health related from gym memberships to over the counter medications to actual care necessities. Further, inexpensive catastrophic insurance for the big ticket items would be also affordable by most. There could be community, charity, and state programs to provide for the neediest, while keeping the federal government taxation hands to itself.

Unless the Congress and President act soon to repeal Obamacare, just rearranging the deck chairs, will not prevent its fate. Already 19 out of 23 taxpayer-funded co-ops have gone bankrupt taking billions of taxpayer dollars with it. And for the phony federal mandates state exchanges, many have only one high price insurer participating, while still others have none. Leave it to the government to mandate you buy something very expensive and then there’s no opportunity to even comply!

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

—————

Dr. Wax,

The deficiencies of state-sponsored health care are widely known. What is difficult to figure out is an alternative — market-based — that is universally accessible and affordable (with affordability being as elastic as elastic can be), while still offering high quality. If there is a model in this world, I am unaware of it.

All efforts America has made to provide public support for health care since World War II, from the VA system to Medicare and Medicaid to Obamacare, have been awkward and grossly inefficient (if somewhat effective, overall). Unfortunately, blowing these systems up and starting a new system based solely on market forces would be catastrophic in the short term. And since politicians think in the short term, such a radical transformation is impossible.

Today’s Republicans realize there is reward in trashing Obamacare, but they also know that they do not have a better plan to replace it. If they really had a better plan they would have introduced it by now, and it would be on President Donald Trump’s desk for signature. The fact that they cannot agree among themselves on a replacement is testimony to how difficult a problem this is. (This does not excuse the Democrats, either.  They’d rather let the Republicans look foolish than offer their own “solutions.”)

Regards,

Bob Wells

Even a Seventh Grader Can Understand the Root Failure of Government-Run Care

From Steven Dailey FACHE:

The first term paper that I ever wrote was titled “Should Medicare and Medicaid Survive?” and was handed in to my seventh grade teach in the spring of 1967. She gave me a “B” because she did not believe that I had interviewed the local hospital administrator whom I quoted extensively in the term paper.

She also marked me down because in her mind, “our government never takes something away that they have already given away. That is just too hard to do.” Maybe she was right about never taking something away -. She was wrong about the interview with the hospital administrator – he was my Dad…. He ran a 500 bed hospital and he absolutely railed against the involvement of government in healthcare.

Many, many hospital administrators did not want Medicare and Medicaid back then. They knew all too well what would happen – regulation and cost increases year after year…. Isn’t it amazing that our public trusted our physicians and hospitals back in the 1960’s and after decades of increasing governmental regulation and trillions of government expenditures healthcare suddenly fails to meet public expectations? It isn’t amazing that when you add insurance coverage to tens of millions that costs will increase? Not really….

58 Hours of CME George Orwell Style

Friend of IP4PI Jane Hughes, MD writes in:

Anyone who thought that things were on hold regarding continued implementation of ACA and the statist move by Medicare via MACRA and its payment scheme called MIPS to centralize and control patient and physician choices needs to read this upcoming offering for unprecedented free CME from one of our premier institutions, Johns Hopkins. Key to centralization is electronic medical records that are interoperable. Read that to mean 24/7 access by government/insurance for data gathering and eventual treatment rubrics. Note that all of these CME hours are not featuring medical or surgical issues, they deal with “educating” and indoctrinating physicians on the advisability of population based care.

This is a sinister turn for the worse. We should have gotten a health plan through in some form to start the dismantling of ACA and trumpet the message that this is the beginning of decentralizing healthcare. Critical to reform of Medicare and getting rid of MACRA is a stable, affordable, and accessible private option.

These sponsoring organizations are proceeding as if nothing has changed. Until Trump appointees get rid of entrenched bureaucrats subversive to the true reform of statist ACA this is no surprise. The collusion with insurance and govt also needs to be exposed. These two forces are insatiable looters of tax monies, people’s premium moneys, individual human dignity, and doctor and physician choices. Note they are offering 58 hours of CME credit/brainwashing. What an impotent feeling to read that even an institution as grand as John Hopkins has succumbed to the George Orwell form of medical care.

Real Patient Lives vs. Corporatized/Government Healthcare, Part IV

The insurance and government dominated system is failing our patients. A physician friend of IP4PI shares this shocking example about the system claiming another victim:

A 59 y/o man presented to my last employed practice, with an almost elephantiasis swelling bilateral legs.  He had pinpoint marks on the skin of his legs.  He held up a jar with what looked like a couple of tiny maggots.  He said, these come out of those holes every so often.  I said how long has this been going on??  He said 1.5 years.  “I’ve mentioned to several doctors, they just shrug and don’t do anything.”  I said we would do something, and called the hospitalist immediately to admit for workup and treatment.  I was directed to the nurse gatekeeper for approval for admission.  What’s wrong, she asked.  “4+ edema in both legs, which are also full of maggots.”  Hmmm, she said.  There is no medicare admissible diagnosis of ‘maggots in legs’.  What about his rising creatinine of 1.7?  Not bad enough to qualify under guidelines.  Call us back if it gets worse.  I did try to do some outpatient workup, but I think the man was disgusted.  He never followed up.  He was dead within the year.