The AMA is utter garbage. But, you knew that.

Here they go again. Once again the AMA is promoting what’s best for the big government / big insurance / big hospital cartel instead of advocating solutions that will truly empower patients, physicians, and increase access to high-quality, low-cost care.

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How can we motivate Congress to act on ACA? End their illegal exemption!

From our friends at Independent Women’s Voice:

For the Senate to pass ObamaCare repeal and replace with only 51 votes, they’ll need to take action by September 30th.

How can we motivate Congress to act? By President Donald J. Trump ending Congress’ illegal exemption from ObamaCare.

Here’s what you need to do STAT:

  1. Sign the petition at www.NoWashingtonExemption.com
  2. Write President Trump and tell him to end the illegal exemption: https://www.whitehouse.gov/contact
  3. Read this explainer from Michael Cannon of CATO to become an expert on this crucial issue: http://www.washingtonexaminer.com/congress-illegal-and-egregious-obamacare-exemption-explained/article/2633383

The solution to healthcare is…

Most agree that we need a healthcare system that encourages people to take care of themselves and covers catastrophic injuries and disease for all people.

I trust the free-market more than government, and some trust the government more than the free market.

MACRA, ACA, HIPAA, HMO act, Medicare and Medicaid were supposed to reduce costs and expenditures. Obviously government only makes it all worse. Looks like a job for the freemarket!

Either way, whichever philosophical system is selected by the people, individuals must freedom of choice and bear their own responsibility to the extent that is humanly possible.

Craig M. Wax DO

CNBC reports:

Medical emergency: ER costs skyrocket, leaving patients in shock

  • Americans are being overcharged by more than $3 billion a year for ER services, according to data from Johns Hopkins School of Medicine.
  • Bills can be nearly 13 times the rates paid by Medicare for the same services.
  • Americans in the Southeast and Midwest, and poor and minority patients, are the most exploited by emergency-room billing practices, especially at for-profit hospitals.

Read full story:

https://www.cnbc.com/2017/08/10/medical-emergency-er-costs-skyrocket-leaving-patients-in-shock.html

57 Million Seniors’ Medical Care Imperiled by Medicare Red Tape

Action is needed this weekend! Take advantage of an opportunity to cut through some of the bureaucratic red tape that imperils the medical care of 57 million seniors. Actually, the regulations in question harm not only Medicare patients, but also put “commercially insured patients and their data under the agency’s control,” explains Dr. Kris Held.

CMS is seeking comments from the public on proposed changes to MACRA rules to be implemented in 2018.

Tell CMS to further widen exemptions from MACRA overregulation for physicians and their patients.

Comments are due by 11:59pm Eastern Daylight Time, Monday, August 21, and can be submitted online at the following link:

https://www.regulations.gov/comment?D=CMS-2017-0082-0002

Here’s an example of what you might say:

MACRA compliance is not compatible with patient-centered medical care. CMS must use all possible discretion authorized under law to free as many physicians as possible, and their patients, from this harmful overregulation. At the very least, practices with 15 physicians or fewer should be exempt from all MACRA penalties.

Additional details:

The U.S. Centers for Medicare & Medicaid Services (CMS) has released proposed changes to its so-called “Quality Payment Program” (QPP) rules for 2018. The QPP “implements provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) related to the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).”

While initially created under the guise of increasing “quality” and “value,” in practice the program attempts to coerce doctors to comply with cookbook medicine and government rationing protocols while at the same time compromising patient privacy.

Fortunately, there are some new faces at CMS who understand the danger of this program and a few helpful changes have been proposed; however the changes don’t go nearly far enough. We are asking CMS to use all possible authority to lessen the burden on patients and physicians.

AAPS is not alone in calling for these needed changes. The Editorial Director of Medical Economics has called on CMS to “Exempt all small practices from the program. … Smaller practices shouldn’t have to play the same game as the larger practices they already compete against every single day when it comes to things like patients, resources and payer influence. Don’t make the alleged ‘failures’ of small practices fund larger practice payment bonuses.”

Please submit your comments to CMS on this crucial issue before the Monday deadline.

Thank you for your help!

~AAPS

For the full proposed rule see:

https://www.regulations.gov/document?D=CMS-2017-0082-0002

And the CMS fact sheet on the changes is available at:

https://qpp.cms.gov/docs/QPP_Proposed_Rule_for_QPP_Year_2.pdf

Opaque Transparency?

Lack of price transparency is one of the biggest problems plaguing American patients and well-intentioned state legislators are now taking a stab legislative fixes.

But is a government mandate the right approach? Dr. Keith Smith, for one, warns that it isn’t.  Here’s a recent example of just what can go wrong.

In one state, Ohio, the legislature passed a law now known as Ohio Revised Statute 5162.80, which has misdiagnosed the disease and has prescribed an ineffective and even potentially harmful cure, particularly for patients tied to an “insurance” plan.

On it’s face the bill seems straightforward: doctors and hospitals must give patients good faith estimates for charges and payments. Who could be opposed to that?

The devil is in the details, particularly in this section of the law:

A provider of medical services shall provide in writing before care is rendered: “The amount the health plan issuer intends to pay for the product, service, or procedure…”

Anyone who has ever tried to get an insurance company to divulge its contracted rates with providers prior to receiving care knows all too well what a herculean task it is.

To their credit, the bill’s authors included a provision to address this problem:

“Any health plan issuer contacted by a provider … shall provide such information to the provider within a reasonable time of the provider’s request.”

Again this looks like a reasonable provision at first glance, but it is really non-transparent transparency and worse could lead to delays in care.

Why should a patient have to contact a physician or facility to find out what his or her insurance plan will pay? This is in reality erecting a barrier between the patient and finding out what the actual costs for care will be at any given doctor or facility. It blocks meaningfully shopping for the best price.

We are not recommending government mandates, but  a more effective requirement might be to demand that the insurers release ALL of their reimbursement rates, both in network and out-of-network, in a transparent manner so that everyone, particularly patients enrolled in a plan, can easily see how much the insurer would pay paying before a patient even sets foot in a doctors office.

The bill as written only requires that the insurers divulge the info on a case by case basis to the “provider.” Why not also to the patient? After all the patient is at least purportedly the actual customer of the insurance company.

As Dr. Michel Accad explains, price opaqueness is a symptom of larger problem, pervasive third-party-payment, and not in itself the root cause.

In a free and competitive healthcare market, price transparency would rarely be an issue, as it is not an issue in the market for cell phones and bubble gum.  Doctors and hospitals could not survive without being upfront about fees.  But, in its great wisdom, and supported by the sound logic of healthcare analysts and healthcare economists, the government has ensured—through its tampering with and participation in health insurance—that charges would be as opaque as possible.

As demonstrated by free market facilities like the Surgery Center of Oklahoma — who post their actual prices not fictitious chargemaster rates — the ultimate solution to not only price transparency, but increasing access to high quality, low cost care, is to kick out the middlemen driving up and obscuring the prices.

Denied? Make Insurance Gatekeepers Responsible Too

“Snippets from the frontline” sent in from Gene Uzawa Dorio, M.D.

You’ve been told surgery required to repair a herniated disc has been denied; a mammogram to evaluate a new lump won’t be allowed; or you must be discharged from the hospital because an insurance company doctor you have never met will not approve further hospitalization.

As my patient’s advocate, I frequently must discuss their care with insurance doctors in peer-to-peer phone conversations. This is what I do starting this conversation: I get the doctor’s name; in what state they are licensed; their specialty; and tell them their name will be placed on the patient’s record as being a participant in medical decision-making.

With that, they must weigh their medical versus financial judgement, and know they might be subject to the same accountability I face. Does this make a difference? Sometimes.

Medical decision-making has been removed from your doctor and given to distant paper pushers of the insurance industry. Urge your physician in their peer-to-peer conversations to make insurance doctors responsible too.

Gene Uzawa Dorio, M.D.

Comments: http://scvphysicianreport.com/2017/07/29/doctors-diary-july-29-2017/

Remember when the AOA worked for their members?

Gina Reghetti, DO shares her response to the AOA’s email alert opposing the repeal of ObamaCare:

Dear Dr. Buser:

I am writing in response to your “Urgent Action” email that I received on July 22, 2017, regarding the repeal of the PPACA, which is attached below.

I do not agree with your position that if the PPACA is repealed it would “significantly jeopardize our heath care system.” Since you represent the AOA as its president, I feel that you are using your position to influence political agendas that are not in the best interest of American patients and their doctors.

I would hope that the AOA does not use doctors’ membership dues and board certification fees to support such agendas that do not support the Osteopathic Philosophy of independent, private, practice osteopathic doctors that deliver one-on-one direct, private care to their patients without government or third party intruders, and that stay true to the practice of Osteopathy, as Andrew Taylor Still, D.O., M.D., founded.

Your stance appears not to support the Free Markets in the USA, and direct pay practices which are far better solutions than a government controlled healthcare system.

I take great insult that the AOA, through your voice as president, uses osteopathic doctors’ hard earned money to push agendas that are not reflective of the American way, and I believe that it constitutes just another AOA federal violation.

I am also very concerned as to why the AOA cashed my ninety dollar check for my board certification dues, yet the website displays that my board certification is inactive for the public to view, when that is incorrect since my board certification is dated to expire in 2022; although it should be a lifetime certification. Worse yet, the message to the public is to indicate that if osteopathic doctors do not hold board certifications through the AOA then they are somehow less qualified to practice medicine. I find this to be very defaming, and I request that this serious issue be corrected immediately and removed from the public website.

I remember when the AOA worked for their osteopathic physicians and surgeons and supported Osteopathy, but over the many years that role does not appear to be so any longer. Rather the AOA uses their power to lobby, such agendas, that are against the osteopathic oath and training of osteopathic physicians and surgeons here in the USA.

The AOA does not correctly reflect the opinions of their doctors; especially, when emails as yours are sent. There is no room for Politics in Medicine!

I would highly recommend that you, and the AOA, cease immediately from sending emails out that reflect your political stance rather than the Osteopathic Profession’s.

I strongly oppose your views as do the majority of practicing physicians and surgeons across this great nation.

Let us keep the United States of America a free nation for all and let us keep the government out of peoples’ lives, and especially out of healthcare, since it will only do more harm than good.

I thank you for your understanding and immediate attention to this serious matter.

I look forward to hearing from you to inform me that my Inactive board status is corrected back to Active status as it should be.

Respectfully,

Gina Reghetti, D.O.
AOA #64509
Attached: Dr. Buser’s email below:

 

 

 

Advocacy Action Alert


Dear Colleagues:

As you may have heard, the Senate will soon vote to repeal the Patient Protection and Affordable Care Act (PPACA) without a legislative alternative. Should this vote be successful, it would significantly jeopardize our heath care system, and result in a loss of coverage and access to care for up to 32 million Americans, and the potential for significant increase in premium costs.

Senators Lisa Murkowski (R-AK), Susan Collins, (R-ME), and Shelley Moore Capito (R-WV) have expressed their opposition and concerns about this plan. It is critical for any health care legislative proposals to achieve a high-quality, patient-centered, and cost-efficient system that meets the needs of our patients. I urge you to contact your senator to express your support for her pragmatic approach to health care reform and her vocal opposition to repealing PPACA without a legislative alternative, in order to ensure our patients have the continued access to health care.
The time is now to write to your senator and support her pragmatic approach to health care to ensure that our aforementioned goals on transforming the health care system focus on our patients.

Boyd R. Buser, DO

AOA President

 *Wondering how the AOA has developed its position on health care reform and the AHCA to date? Watch our webinar that explains the process.