Forget Pens, How About Banning Kickbacks?

Back in 2008 the Pharmaceutical industry ostensibly took the high road and called for a moratorium on branded items handed out to doctors. No more free pens. Then in 2010 the Physician Payment Sunshine Act cemented in place red tape impeding other gifts to physicians. No more free lunches … with out filling out a form for Uncle Sam.

Well the truth is: “We’ve got big problems in health care, and I don’t think the problem is pens,” stated Houston physician Stephen Lapin, MD, speaking what was on the mind of virtually, if not literally, every physician.

These changes didn’t accomplish much if anything but a few warm fuzzy feelings for politicians, while the folks in C-Suites likely congratulated each other with a slap on the back for yet again shifting the blame onto doctors and covering up their own corruption.

This time doctors are fighting back and asking for real change, change with the potential to save patients to the tune of $100 billion dollars. How? By axing out the Pharmaceutical industry kickbacks being used to bribe the middlemen in control of American’s pharmaceutical benefits.

Your action is needed by July 16 to help end these improper bribes that are driving up costs, creating shortages, and controlling the prescriptions covered by your plan.

Speaking out is easy and instructions can be found here: https://aapsonline.org/alert-and-special-legislative-update-pharmacy-benefits-managers/.

 

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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

Tell CMS to Protect Patients and Physicians from Harmful Red Tape

CMS has released the proposed 2018 regulations for MACRA and is asking for comments.  The new changes don’t go far enough to protect independent physicians and their patients from harmful red tape.

CMS has a fact sheet about the proposed rule available here:

Comments are dues August 21 and can be submitted here:
https://www.regulations.gov/document?D=CMS-2017-0082-0002

Dr. Marcy Zwelling had put together sample comments to help everyone get the correct message to CMS.

Below are comments that you can cut and paste –

Medicare Administrators: 

We appreciate the sentiment of the new MIPS regulations, but it does not get the job done for many physicians struggling to go to work and NOT sit behind a computer all day. America’s physicians need to be able to just do our job and struggling with computers does not help us get it done.  It is not about micro-managing the regulations; it’s about our professionalism. 

We understand the statutory constraints, and we think we have the answer.  If the regulations could be edited to read 

Exemptions permitted:

Clinicians below the low-volume threshold – Medicare Part B allowed charges per physician less than or equal to $90,000 OR 200 or fewer Medicare Part B patients per physician up to a 6 person practice. 

Thank you for your serious consideration.  While this change does not save all small practices, we feel that this minor change will send the right message to American physicians and will encourage physicians to work with CMS and keep their offices open. 

 Further, we encourage CMS to follow thru with Dr. Price’s commitment to allow physicians to balance bill as a means of enhancing our patients’ options and keeping physicians’ doors open. 

True Patient Centered Reform: Revisiting Dr. Paul Broun’s Patient OPTION Act

According to our friends at Freedom Works:

“Section 1 of his bold, principled plan repeals ObamaCare in its entirety. That alone would make it worth supporting, but he goes much farther. Inspired by the vision of a truly patient-centered system, his bill addresses the spiraling cost of health care and lack of consumer control in a number of commonsense ways.”

The OPTION Act eliminates the requirement that HSAs be attached to high-deductible health plans, allowing all Americans to save money for a rainy day tax-free. Continue reading

Trump calls a congressman physician to lead real patient-centered reform at HHS

IP4PI joins patients and physicians across the United States in cheering the appointment of Congressman and orthopedic surgeon Tom Price, MD to head the Department of Health and Human Services in the incoming Trump administration.

Dr. Price has a long history of standing up for the patient-physician relationship against the myriad forces seeking to intervene to the detriment of quality patient care.  And indeed, proponents of top-down government control are quickly sounding the alarm  realizing they have an enemy in the congressman & good doctor from Georgia.

We look forward to supporting Dr. Price in his efforts to roll back ObamaCare, MACRA, MU and many other failed policies harmful to American medicine. Proven patient-centered solutions can then be unleashed to increase access to high-quality, low-cost medical care.

Congratulation’s Dr. Price on this well-deserved new job!  We are here to help you in this crucial and challenging work over the coming years.  The future of American patients and physicians will depend on it.

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

A Tool for Patients to Bypass MACRA Rationing and Privacy Intrusion?

Could the below HHS regulation be a potential tool to help patients do an end run around MACRA privacy intrusions and rationing guidelinesMedicare patients CAN refuse to authorize the filing of a Medicare claim and pay cash as outlined below.
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In 2013 HHS updated HIPAA regulations giving cash-paying patients greater ability to restrict the disclosure of health information.  Here’s what the final rule states about Medicarepatients’ ability to assert this right:

Continue reading