DAY IN DC FOR THE GOOD OF PATIENTS-empowering physicians to put patients first.

In the Oath of Hippocrates, physicians promise to work for the good of their patients, according to the best of their ability and judgment, and to do no harm. We support a return to this ethic in American medicine, and oppose policies that harm patients by subjugating care to the interest of the government and third parties.

Reform Issues:

• Overregulation and mandates restrict access, stifle innovation, impede transparency, block competition & raise costs.
• Fraud, waste, and shortages are rampant because special favors to middlemen.
• Employer-based and government-run insurance discourages rational insurance practices.
• Medicare and Medicaid are bankrupting the federal government, states, and doctors.
• In the era of COVID, the consequences of usurping of patient and physician autonomy and freedoms are becoming increasingly apparent and dangerous.

Proposed Solutions: to protect freedom, increase options, encourage competition, and unwind unsustainable spending.

1. End mask, vaccine, and other mandates and policies that intrude on patient autonomy. This also includes protecting Americans from World Health Organization policies that too often become mandates.
2. Protect physician and patient freedom of speech in all venues, including the Internet. The government and media must not limit legal speech and must be transparent about their sources of funding and control. (See Texas HB 20.)
3. Protect physician and patient autonomy in treatment and vaccination decisions. Early treatment for COVID saves lives and should not be improperly blocked by government or other bureaucrats. See AZ SB 1416 and MO HB 2149). Vaccine mandates are hurting vulnerable patients at low risk for COVID and must end. (See FL HB 1B, 3B, 5B, 7B).
4. Protect due process rights of physicians who too often face retaliation, simply for advocating for patients, by employers, hospital administrators, licensing boards, and others who control their ability to practice. Needed reforms include repealing HCQIA’s qualified immunity for sham peer review, reform of the National Practitioner Databank, and rights for physicians employed by private equity controlled corporations.
5. Work toward independence from China CCP medications, tech, manufacturing, goods and WHO influence.
6. End regulations blocking alternatives to ACA, employment-based, Medicare, and Medicaid plans, while allowing those who wish to keep their current government plan to do so.
7. End ACA’s ban on physician owned hospitals. Section 6001 of the Affordable Care Act of amended section 1877 of the Social Security Act to generally prohibited those who know best how to care for patients from running the facilities where care for the most seriously ill and injured often takes place.
8. Encourage transparency. Health care entities receiving taxpayer-subsidized funds from any source must disclose all prices that are accepted as payment in full for products and services furnished to individual consumers. Transparency by agencies (FDA, CDC, NIH, etc.) that control and influence health policy and treatment guidelines is also paramount. Transparency in training, so that patients know the qualifications of the clinicians caring for them, is also needed as patients are increasingly pushed to obtain care from individuals with significantly less training than physicians. Databases disclosing potential conflicts of interest must include all entities receiving or offering payments (e.g. device and pharmaceutical manufacturers, PBMs, GPOs, hospitals, insurers) not just physicians.
9. Remove legal protection for kickbacks. Remedy GPO and PBM abuse of safe harbors by encouraging Congress to repeal 42 U.S.C. § 1320a-7b(b)(3)(C) and amplifying HHS-OIG efforts to stop exploitation of 42 C.F.R. § 1001.952(j) and related regulations. Ending kickbacks is a crucial aspect of ending America’s reliance on China for drugs and supplies.
10. Decouple Social Security benefits from Medicare Part A. Citizens should be permitted to disenroll from Medicare Part A without forgoing Social Security payments. This would immediately decrease government spending and open the potential for a true insurance market for the over-65 population.
11. Repeal Medicaid rules that decrease Medicaid patients’ access to independent physicians. ACA requires physicians ordering and prescribing for Medicaid patients to be enrolled in Medicaid. This creates barriers for Medicaid patients who seek care from independent physicians but wish to use Medicaid benefits for prescriptions, diagnostics, and hospital fees. This is a particular problem for Medicaid patients seeking treatment for opioid addiction.
12. Explicitly define direct patient care (DPC) agreements as medical care (instead of insurance) so patients can use their HSAs, HRAs and FSAs for DPC.
13. Expand Health Savings Accounts (HSAs).  Examples of needed reform include repealing the requirement that an individual making a tax-deductible contribution to an HSA be covered by a high deductible health care plan; increasing the maximum HSA contribution level; allowing Medicare eligible individuals to contribute to an HSA. HSA reform will help end tax discrimination. Individual’s payments for medical care should not be taxed differently than payments made by employers.
14. End Restrictions on Health Sharing Ministries. Open the door for secular charitable sharing plans. Health Care Sharing Plans engage in voluntary sharing and are not a contractual transfer of risk.
15. Encourage indemnity insurance and competition instead of managed care HMO plans. No limited networks of physicians and facilities.
16. Address shortcomings of the No Surprises Act, that unfairly increase insurance company control over the ability of patients’ to access care from the physicians of their choice on mutually agreeable terms and that increase red tape for physicians.
17. Increase options for addressing pre-existing conditions. Invigoration of competition, by implementing the above changes, would bring a variety of products for patients with pre-existing conditions, including reinsurance, and inexpensive guaranteed issue and renewability protections, and most importantly, lower overall cost of care.

Conclusion: Congress has passed law after law that disrupts the patient-physician relationship, corrupts medical decision making, and increases costs. During the COVID era, overregulation and regulatory capture is a greater threat to our nation than ever.   Harmful laws and policies cannot be fixed by adding new regulatory burdens or further usurping patient and physician autonomy. True reform starts with repealing laws and correcting errors, restoring the freedom, under constitutionally limited government, that made America great.

What is Healthcare? And How to Fund It.

Dear Chairman Alexander,

Thank you very much for asking America’s MD and DO Physicians to weigh in on solutions to improve Americans’ health and launch an efficient and sustainable path for the healthcare ecosystem.

The first critical step is educating your colleagues that there is a difference between medical care and health insurance. My recent article published in Medical Economics may help policymakers understand that the difference matters: https://www.medicaleconomics.com/med-ec-blog/what-healthcare

Solving the current healthcare policy disaster ultimately means less federal intervention and regulation, combined with more freedom and liberty.

Please consider:

1. Expanded universal HSA heath savings accounts for all, independent of insurance, and usable for every healthcare service, medication and device.

2. Remove ACA restrictions on insurance policies and stop multi-billion dollar bailouts of the insurance industry. Insurers have driven up costs. Instead allow a diversity of insurance plans to compete side by side: from catastrophic with high deductible to first dollar HMO-coverage. Unique individuals should be shopping for unique plans to suit their own needs.

3. Repeal the Group Purchasing Organization safe harbor to the Anti Kickback Statute that is also being abused by Pharmacy Benefits Managers. The federal government has permitted kickbacks disguised as “rebates“ for decades and it must stop. Make kickbacks illegal again. GPO and PBM middleman must compete legally and not extort manufacturers.

4. Innovative solutions like Direct Primary Care (DPC), and similar direct payment arrangements between specialists and their patients are must not be subject to over-regulation under insurance rules . These arrangements are not insurance but cut out the third party bureaucracy driving up the cost of care. DPC serves to strengthen patient-physician relationships not interfere in them. This healing relationship is critical for regaining health and health maintenance. It makes both patients and physicians responsible to each other directly, as it should be.

5. Allow physicians and patients to opt out of Medicare, MACRA, and other top-down government programs. They should be voluntary, not compulsory. Direct contracting between patient and physicians will save lives and tax dollars.

6. Consider legislation to protect patient access to physicians of their choice, even if they are not in their plan’s network. Narrow networks serve to trap patients into obtaining care in the most expensive settings instead of from higher quality and less expensive options like independent physicians.

Please feel free to contact me via letter, email, social media, phone, or any other mechanism for short and long-term planning. Together we can harness free market and personal individual responsibility to organically solve America’s healthcare crisis.

My article catalog: https://www.medicaleconomics.com/authors/craig-m-wax-do

Best wishes for good health,

Craig M. Wax, DO
Family Physician
VP Healthcare Policy, Practicing Physicians of America
National Physicians Council on Healthcare Policy member
Independent Physicians for Patient Independence
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax
HealthIsNumberOne.com

Less is More: take the deductions for MACRA non-compliance

Friend of IP4PI, Jane Hughes, MD writes in:

Greetings,

Read this BS sent to us by our “professional” organization whose mission is to preserve the profession, etc etc. For the love of God I cannot understand why any physician can’t see by now that this is a fool’s errand and meant to be. Our clarion call should be to all doctors: Take the deductions for non-compliance because: you will save in essence $40,000/yr in compliance costs that would take $430,000 in Medicare payments at the 9% top reward to equal your $40,000 reimbursement before you see a penny in increased payments. More importantly, you can proudly state that you are saving the government (taxpayers) money at the same time. And the best, wait for it- it would go away because no one would be doing it.

This is not to say I have given up on reform. But, to change Medicare we have to straighten out the private sector, and then, with insolvency looming, we can give Medicare ppl a choice- defined monthly contribution (i.e. check like Social Security) or continued traditional Medicare, which would also be a fast disappearing institution with the current costs to “beneficiaries.” Gee, HSAs with no networks, Medicare as catastrophic, and cash pricing versus what we have now… pipe dream worth fighting for. As you can see I almost came off the rails reading this stuff.

Warm regards,
Jane

More Fed carrots? Or just a different stick? #MACRA #MIPS

Secretary Azar says HHS may cease reporting requirements for MIPS “value-based” care. Perhaps you’re beginning to think that they are finally hearing us, right?

However reading further, things get murky fast:

Instead of requiring physicians who participate in MIPS to submit patient data, the proposal suggests having the government use claims data and patient surveys to grade doctors in the program. “We would be able to independently look at data ourselves to decide their compliance with the quality programs rather than their having to even report anything,” Azar said at Thursday’s hearing.

Here’s what some physicians are saying about this “new direction” from HHS:

• I’m not going to celebrate just yet. Think of how often HHS/CMS have replaced a bad idea they had, with an even worse idea. If they begin using patient surveys (Press Gainey, etc.) to determine whether or not physicians are given a bonus or penalty, I think that could actually make this awful MIPS experiment even worse.
• We must be careful what we ask for- and we must control the conversation. There is no reason the government needs to be involved at all – that’s the beautiful thing about the free market – the patient receiving the service determines the value – but the patient must have an  appreciable fiduciary responsibility and they vote with their wallet – good restaurants are busy – bad restaurants are closed – really quite simple.
• MACRA/MIPS  is fatally flawed.  Patients are individuals and cannot be reduced to an algorithm.
• There is nothing salvageable or workable in the MIPS system. There is no way on paper and with claims that physician skill, judgement or even outcomes can be legitimately assessed. Further, major institutions are rethinking patient evaluations of physicians, realizing that it is a one way system-i.e. there is no way to evaluate the validity of the patient evaluation and no way for the physician to respond.
  In my opinion our best/only meaningful way of reform is to condemn the entire MACRA/MIPS construct as wasteful and invalid without adding anything to patient care. In fact a point can be made that it detracts from actual care.
• We should have a say in the type of patient survey they set up. And this should decide only incentives not penalties. The only difference between this and MIPS is that with MIPS we can lose money after spending it on data collection, whereas here we avoid double jeopardy because they do their own data collection and we don’t have to attest to anything. Overall I think what they have suggested is better than MIPS.
• I just had a very cranky daughter complain about the resident who called her sister rather than her when her mother took a turn for the worst. She would give that resident a failing grade. So much subjectivity makes those evaluation meaningless. Also, when grading a physician on outcomes, which physician can take credit for which specific outcome? Many physicians are often involved. This evaluation scheme is totally unworkable.

I think you’ll agree there is more than a bit of skepticism that CMS is going to meaningfully change things for the better. Tell us what you think!

MACRA MIPS? Time for GACRA GIPS to hold lawmakers accountable.

How can we hold Congress accountable for the failed policy they continue to foist on American patients and doctors?

Meet GACRA GIPS, the Government Accountability Credibility Realignment Assessment and Government Incentive Payment System.

With GACRA GIPS, if congressmen and congresswomen don’t work, vote, complete their tasks and create a budget that lives within our means well paying down the national debt, they don’t get paid.

Learn more about this needed reform in the latest article by IP4PI founder Craig M. Wax, DO published by Medical Economics:

http://medicaleconomics.modernmedicine.com/medical-economics/news/your-voice-physician-accountability-let-s-legislate-congressional-accountability

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

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:

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

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. 

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

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.