Do Not Gloss Over the Devastating Impacts of Policies that Declare Mid-Levels are Equivalent to Physicians

Friend of IP4PI Amy Townsend, MD writes in:

Please do not gloss over the potentially devastating impacts that Section 5 of President Trump’s Executive Order on Medicare will have on our healthcare system.  

I am a board member for Physicians for Patient Protection, a grassroots physician group that promotes physician led care.  We have been actively fighting scope of practice invasion in nearly every state for the last 3 years.  NPs and PAs can be a valuable part of a physician led team but they are not equivalent to physicians in education, training, or ability.  The government permitting them to independently practice medicine through legislation and not education will devastate healthcare.  Here are a few of my concerns:

1.  Patient safety, patient safety, patient safety!!!!

As NPs try to increase their numbers, they have sacrificed the quality of NP education.  They have created degree mills that are churning out 27,000 NPs per year.  Many schools have 100% acceptance and didactics that are 100% online and can be completed in as little as 18 months.  This is followed by a mere 500 hours of shadowing as their “clinical experience”.  Compare this to 16,000 clinical hours for a family medicine physician.  We are seeing and hearing devastating stories of misdiagnosis and mismanagement of these poorly trained practitioners daily.

2.  Medical expertise will be gradually diluted down.  

Why will our best and brightest students even try to conquer to academic rigors and expense of medical school when you can take a cheaper, less time consuming course to practicing medicine independently and have the same reimbursement (due to pay parity proposed here).  As a Family Medicine physician that has been practicing almost 15 years, I value every second of my training.  It is needed for me to be an expert at my craft.  

3.  NPs and to a lesser extent PAs, in general are corporate YES men.  

They have not been taught in their training to take ownership of patients as physicians do.  They do not take the same oath to protect patients at all costs.  If they are declared physician equals and can replace physicians, we will lose all negotiating power with corporate entities, government, and insurance companies.  If physicians stand up for patients, they will simply be replaced by a more agreeable, complacent NP.  
There are probably a million additional reasons.  But it is late and I’m sure you all are tired of reading my rant.  But I am begging you all to please give this issue it’s due respect.  The president has it WRONG on this issue.  We can not continue to have this conversations in the dark corners because we are afraid of liking like we are being mean to nurses.  Our profession, our fellow physicians, and our patients need us to speak up.  

Thank you all for your wonderful advocacy.  I believe it is people like us that can and will fix our broken system. 


Amy Townsend, MD, Family Medicine/Hospital Medicine

President Trump’s Salute to Patients Promises Welcome Changes, But Special Interests Attack

The week before President Trump’s Independence Day “Salute to America” he gave a welcome Salute to Patients when he signed Executive Order 13877, “Improving Price and Quality Transparency in American Healthcare To Put Patients First.”

As free market champion Dr. Keith Smith of the Surgery Center of Oklahoma puts it, the “healthcare industry price gougers wore out their welcome” and were “kicked to the curb by President Trump.”

What does the order do? Its first priority is to end “opaque pricing structures,” that “benefit powerful special interest groups, such as large hospital systems and insurance companies,” but, “generally leave patients and taxpayers worse off than would a more transparent system.”

But there’s more: the order also aims to “enhance patients’ control over their own healthcare resources” by removing failed policies that impede patients from choosing to enroll in affordable Direct Primary Care practices or alternatives to big insurance like Health Care Sharing Ministries.

The bottom line is increasing patient freedom and choice is the centerpiece of President Trump’s order. However, make no mistake, it is also put a target squarely on the middlemen who have for too long taken advantage of backroom deals made with government cronies. And the middlemen are already fighting back with a vengeance and working to undermine the order.

Underestimating the special interests’ power to stop the good changes is not an option. Just last week the Pharmacy Benefits Manager (PBM) cartel killed a White House proposal that would begin to unwind corrupt kickbacks that result in out of control price hikes for life saving drugs through disingenuous propaganda that lower prices would somehow raise premiums.

And the fake news campaigns about the Transparency Order are already underway.

Thankfully physicians like Chad Savage, MD are debunking the industry lies:

No price transparency will not lead to higher prices. “This is akin to saying the best way to get a good price on a new Sony TV is to have no idea what it costs. If someone said that to you, you would rightly reject any future advice from that individual,” explains Dr. Savage.

Marni Jamison of the Association of Independent Doctors exposes another tactic of those who oppose transparency:

The cronies are “lawyering and lobbying up, busily working to undermine, narrow and water down the order. They are not going to give up the hundreds of billions of excess dollars flowing their way easily,” she writes and shares examples of weasel words insurers and mega health systems will attempt to use to corrupt the outcome.

Middlemen’s fingerprints are already evident on the order itself to some extent. For example the “Health Quality Roadmap” provisions empower the use of failed quality metrics that are already driving up the cost of care with out any benefit to outcomes. “Practitioners who practice according to the needs of their individual patients, not according to some standardized protocol approved by a third party whose only focus may be efficiency and cost-cutting, may be penalized,” warns Twila Brase of the Citizens’ Council for Health Freedom and award-winning author of Big Brother in the Exam Room. AAPS, while overall supportive of the order, flagged provisions as potentially harmful to privacy rights and urged that “patients’ right to consent to use of their data must also be respected.”

Winning these battles for patients and those who care for them will not be easy! But nothing worthwhile ever is. So let’s all Salute President Trump for taking these bold steps by stepping to help him fend off the special interests trying to thwart his welcome orders.

Promoting Choice and Competition to Empower Patients and their Physicians

A friend of IP4PI writes in:
I just read President Trump’s executive order on choice and competition across state lines. It has these amazing provisions which have not been discussed in the media at all!! These provisions go to the heart of a competitive market-based healthcare system.
“(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system. To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should:
(i) expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs;
(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power; and
(iii) improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes, while minimizing reporting burdens on affected plans, providers, or payers.”
The whole order can be read here: https://www.whitehouse.gov/the-press-office/2017/10/12/presidential-executive-order-promoting-healthcare-choice-and-competition . I love the title to promote choice and competition.  I don’t think the order was overreach, because the language is to ” PRIORITIZE three areas for improvement in the near term: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).” and “FOCUS on promoting competition in healthcare markets and limiting excessive consolidation “.  I did note this part:” Public Comment. The Secretaries shall consider and evaluate public comments on any regulations proposed under sections 2 through 4 of this order.”
Stay tuned for opportunities to comment!