Eliminating the six degrees of patient-physician separation

By Craig M. Wax, DO

Parties and special interests within the US federal government have been trying to passively and actively control the health and welfare of its citizens for a century. With the War Labor Board’s wage and price controls instituted in 1943 during WWII, the US federal government first warped both the employer/employee workplace and healthcare by firmly establishing health insurance as a employee “benefit” in lieu of salary. The premiums were paid with pretax dollars by a combination of the employer and employee.

This gave the employer the power to choose the coverage based on the employer’s needs and wants, not the end user employees needs and wants. This was the first degree of separation.

The insurance premium was used as a bet against the employee getting sick. Today, the insurance companies and other third parties make money by denying the healthcare payment for services, studies, tests and medications. After the insurance company processes healthcare provider claims, they make restrictive and sometimes arbitrary decisions about whether to fund the care, tests and medications. This leaves the patient on the hook for associated costs, despite the insurance premium already paid. This is the second degree of separation. Continue reading

Physicians must take back control over definition of quality in medicine

Guest Post by Cynthia Marcotte Stamer, Esq.

Balanced billing is an important element, but only works if physicians recapture control over the quality question.   That’s why in addition to anything else physicians do, physicians must work to take back control over the right to define quality in medicine by controlling or beating back payer driven, cost motivated PQRS and other quality rankings that demonize physicians for practicing better medicine than what payers want to pay for both by demanding meaningful input to the design and quality standards and processes, pushing for reform that prevents payers and the government from misaligning and punishing physicians that put patients first, and other actions that ensure that patients put their confidence and control of care in the hands of physicians not payers or the government.   CMS recently extended the comment deadline on the 2016 PRQS Quality Measure Plan to March 1.  See CMS Seeks Public Comments on Draft Quality Measure Development Plan (MDP) by March 1, 2016 (1-29-2016). See here.  I urge everyone to review and submit meaningful comments on these proposed quality measures as whether or not you use to participate, they will be used to rate you. Continue reading