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.

Malpractice Costs Will Soar if NPs are Deemed On Par With Physicians

Dear Administrator Verma,

Deeming non-physicians to be essentially equal in training and experience to physicians amounts to a dangerous experiment on American patients. It is improper and unethical for the federal government to be making such decisions regarding the scope of practice of medical professionals.

I have spent over 40 years as a complex litigation specialist. Handling over 35,000 malpractice claims. It seems the law of unintended consequences is at play. Currently the “Captain of the Ship” doctrine limits liability to allied health personnel. It also limits professional and legal liability costs. Placing nurse practitioners and Physician assistants on par will indeed lead to greater claim frequency and increased legal costs. Rates for all providers will increase. In fact underwriters will increase offices with PA’s and NP’s. We could see malpractice costs for internal medicine practices rise from $1-3,000 to $9-12,000 per allied health professional .

We saw the law of unintended consequences occur with EHR and once down that “rabbit hole” there is no return. There is both a patient and physician expense that has not been calculated.

Likewise it is irrational and counterproductive to pay a minimally trained person the same as a highly trained, experienced person. If the reimbursement is the same for poor quality as for good quality, but the poor quality costs less to provide, the entities that degrade quality have a competitive economic advantage. Medicare’s existing price controls are already impeding patient access to high quality care and should not be exacerbated by additional flawed policies that further disregard important differences between practitioners. 

The bottom line is that patients’ lives are at risk. The federal government should follow a policy of “first do no harm.” It violates this principle to impose top-down edicts declaring that non-physicians are qualified to practice medicine. I urge the federal government to reject such policies.

Peter Leone

President, Edge Professional Liability Services https://edgepro.net/

Fact Checking Sen. Menendez ACA Diatribe

Dear Senator Menendez,

As a N.J. citizen, taxpayer, physician, husband and father, I must offer factual correction on your healthcare policy ACA diatribes.

You tweeted:

Have a pre-exisiting condition?
Enrolled in Medicare?
On your parent’s healthcare?
Covered through the Medicaid expansion?

President Trump is attacking YOU by attacking the Affordable Care Act. #SaveOurCare pic.twitter.com/gjgMePcZsG

— Senator Bob Menendez (@SenatorMenendez) April 3, 2019

Nothing could be further from the truth in your partisan message:

1. Insurance coverage is not healthcare.
2. Forcing citizens into ACA Medicaid at taxpayer expense is foolhardy.
3. ACA through “guaranteed issue(preexisting conditions)” destroyed the risk pools that kept prices stable. Now ALL commercial plans premiums have doubled and tripled.
4. The individual insurance market was decimated by ACA, destroying any semblance of insurance competition.
5. ACA put most private practice independent physicians, that are more efficient and cheaper, out of business and working for hospitals. As you know, hospitals inflated pricing schemes also extorts taxpayer dollars
6. ACA also pushed insurers toward “narrow networks.” eliminated patients long-term relationships with physicians and further limited their choice of physician and facility.
7. ACA and forced government dependence will bankrupt the country and its citizens, as a whole and individually.
8. Remember the three big lies of Obamacare? Keep your doctor. Keep your insurance. Each family will save $2500. All proven false partisan narrative.
9. Attacking the president of the United States is a waste of time, money and energy when he would gladly work with you on these issues.

I would be glad to work with you and other legislators on competitive free-market plans and assure quality and give patients best choice and restore personal responsibility and freedom.

Sincerely
Craig M. Wax DO
Independent family physician, media host and healthcare policy expert

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

Med Student Debt: Veritas vos liberabit.

Guest post by Howard C. Mandel M.D., FACOG:

The electorate will be bombarded in both the 2018 and 2020 election about the $1.4 trillion in education loans outstanding and the 28% currently in default, though a recent Brookings analysis predicts it will increase up to 40% [https://www.brookings.edu/research/the-looming-student-loan-default-crisis-is-worse-than-we-thought/]

The overwhelming majority of these individuals were either sold a bill of goods by for-profit schools or never graduated the public institutions that they enrolled in. Although medical or dental student debt has been shown to impact career choices it rarely results in default.

Did we ever seriously ask ourselves why medical schools are currently so expensive? Where is all that money going? Do the faculties and administrations of our med schools deserve the salaries and benefits they earn?

Are you aware that many medical schools are now paying hospitals to place their students in 3rd and 4th year clinical rotations… what audacity. These hospitals couldn’t exist without Medicare, Medicaid and DSH federal funding——they should be honored to have students on their wards.

Bad policy and Medicare financing of graduate medical education have created the debt crisis for America’s health care workers. There is a major shortage of doctors and nurses and Congress is ignoring treating this because of the economic costs associated with addressing it.

Yet, the inside the beltway crowd has seen a symptom it can campaign on. The right:  Loan default, and made the wrong diagnosis—–people are not educated with the “right major that’s marketable…”  The left: public college should be free for all. Quoting the late community activist, Mimi West, “Free ain’t Cheap…”

National data is biased by the defaults of mostly students that went to extremely large public institutions [not their state flagships] that either dropped out or took 6+ years to graduate. These students probably were not four year college ready and their loans were compounding all the time that they were finding themselves, experimenting with living on their own and maturing into adulthood. The last few decades have seen ever increasing college costs including tuition, fees, room and board.

http://articles.latimes.com/2011/oct/26/local/la-me-college-costs-20111026
 
http://www.learnliberty.org/videos/how-do-we-break-cycle-higher-t/

Society and government leaders pushed an idealistic desire to have every American attain a college education. This goal was encouraged and supported by government employee unions including most public colleges and universities, unionized workers including in many states, professorship. This led to major impacts on state budgets and college costs.

https://object.cato.org/sites/cato.org/files/serials/files/cato-journal/2010/1/cj30n1-5.pdf
 
https://www.heritage.org/jobs-and-labor/report/how-government-unions-affect-state-and-local-finances-empirical-50-state

It also led to inefficiency as well as difficulties for dedicated students to graduate within four years.

https://www.wsj.com/articles/SB10001424052748704657704576149941061124736

 http://www.hup.harvard.edu/catalog.php?isbn=9780674027886

In 2004, Johns Hopkins professors Robert Balfanz and Nettie Legters published an analysis entitled, “Locating the Dropout Crisis. Which High Schools Produce the Nation’s Dropouts? Where are they Located? Who attends Them?”
https://files.eric.ed.gov/fulltext/ED484525.pdf    These schools and other “Factories of Failure” pushed through students who ended up either going to For-Profit Institutions, over crowded Community Colleges or large state institutions.  At the California State Colleges/Universities——-75% of these students need remedial English or Math.  Is it any wonder that the majority never graduate but have accumulated debt?

LAUSD administration claims that “56% of their graduates” are college ready. They are not—-most go to Cal State and need remedial work to even begin introductory college level classes. This 56% is of the only 70% that make it to high school graduation. Unfortunatel, they have previously manipulated data and created sham’s, like their credit recovery program, that inflate the success of students only on paper. As a society we are letting the students in the LA district down.  https://achieve.lausd.net/cms/lib/CA01000043/Centricity/domain/414/documents/Dropout%20and%20Graduation%20Statistics%20for%202010-2011.pdf    

Unless we honestly look at the results we will never develop programs that educate our students to succeed. Of the cohort of students entering high school in LAUSD, only 12.25% actually graduate with either a two year or four year college degree in a total of 6 years after they graduated LAUSD. When looking at the percentage of kids who graduate with “A’s”, only 52% will even graduate any 4 year college within 6 years. Looking at the last year that national comparisons were available, only 1,071 students (4.6%) were in the top quartile of the SAT/ACT.   https://ucla.app.box.com/s/xd8lth2fgy1qdyphmwuj2i7cgyurdwf5

So lets look at who is getting loans in America—-by the numbers, the vast majority are at Community or 2nd tier state colleges. 48% of straight “A” students from LAUSD will not graduate by 6 years and most of the those never graduate. As the school’s tuition’s are not extremely expensive, the overwhelming majority of their loans were used for living expenses for 6 to 8 years and the majority of their debt directly related to inflated costs of living on or near state college campuses, “special fees” to support athletics and recreational centers, bank fees and compounded interest on their balances.

Our philosophical desire to be egalitarian and support college education for all has been manipulated by a public college industrial complex that accepts kids that are not college material at the point they enter. If those students went to community college and lived at home, the billions saved could be given to support smaller but higher quality state colleges and make tuition lower for all who attend. Additionally, extra funds would be left over that could actually provide free housing for academically qualified students that are currently homeless, larger graduate student stipends, medical student scholarships and funding for post docs as well.

Until we truly address the problem, we’ll waste time, money and energy on snake oil that will not cure the disease. The government wants to force physicians to be paid for “performance”, yet the public schools from K through University just want Carte Blanche funding sponsored by taxes or at the college level, loans that often get written off.

Howard C. Mandel M.D., FACOG
Dr. Mandel is an advocate and philanthropist for indigent health care, inner city educational opportunity and a smaller, more efficient government
Los Angeles

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

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. 

A Conversation: Can Free Markets Save American Medicine?

A recent article from the Mises Institute. “Under Socialized Medicine, The State Owns You,” sparked a conversation between Mr. Bob Wells and IP4PI founder Dr. Craig M. Wax.

Bob

I appreciate your assessment of the solutions presented like VA, Medicare and Medicaid being awkward, too expensive, and failing in large demonstrable ways. We haven’t had true market based medicine since World War II. Prior to that, it was relatively inexpensive cash and Barter based services. I argue this is the most efficient as it cuts out insurance, pharmacy benefits managers, all levels of administration, and last but not least, all aspects of government regulation compliance and taxation.

In the last six years there have been at least 12 plans on the table to repeal Obamacare. And, there have been six in the last 12 months. There was no sparsity of plans, just no palpable consensus.

I assert that inexpensive primary care, labs, low-end studies, cheap generic medications, will allow for most needs to be met by most people. And expanded health savings account HSA would be used for each citizen to use pretax dollars to buy anything health related from gym memberships to over the counter medications to actual care necessities. Further, inexpensive catastrophic insurance for the big ticket items would be also affordable by most. There could be community, charity, and state programs to provide for the neediest, while keeping the federal government taxation hands to itself.

Unless the Congress and President act soon to repeal Obamacare, just rearranging the deck chairs, will not prevent its fate. Already 19 out of 23 taxpayer-funded co-ops have gone bankrupt taking billions of taxpayer dollars with it. And for the phony federal mandates state exchanges, many have only one high price insurer participating, while still others have none. Leave it to the government to mandate you buy something very expensive and then there’s no opportunity to even comply!

Best wishes for good health,
Craig M. Wax, DO

—————

Dr. Wax,

The deficiencies of state-sponsored health care are widely known. What is difficult to figure out is an alternative — market-based — that is universally accessible and affordable (with affordability being as elastic as elastic can be), while still offering high quality. If there is a model in this world, I am unaware of it.

All efforts America has made to provide public support for health care since World War II, from the VA system to Medicare and Medicaid to Obamacare, have been awkward and grossly inefficient (if somewhat effective, overall). Unfortunately, blowing these systems up and starting a new system based solely on market forces would be catastrophic in the short term. And since politicians think in the short term, such a radical transformation is impossible.

Today’s Republicans realize there is reward in trashing Obamacare, but they also know that they do not have a better plan to replace it. If they really had a better plan they would have introduced it by now, and it would be on President Donald Trump’s desk for signature. The fact that they cannot agree among themselves on a replacement is testimony to how difficult a problem this is. (This does not excuse the Democrats, either.  They’d rather let the Republicans look foolish than offer their own “solutions.”)

Regards,

Bob Wells

Even a Seventh Grader Can Understand the Root Failure of Government-Run Care

From Steven Dailey FACHE:

The first term paper that I ever wrote was titled “Should Medicare and Medicaid Survive?” and was handed in to my seventh grade teach in the spring of 1967. She gave me a “B” because she did not believe that I had interviewed the local hospital administrator whom I quoted extensively in the term paper.

She also marked me down because in her mind, “our government never takes something away that they have already given away. That is just too hard to do.” Maybe she was right about never taking something away -. She was wrong about the interview with the hospital administrator – he was my Dad…. He ran a 500 bed hospital and he absolutely railed against the involvement of government in healthcare.

Many, many hospital administrators did not want Medicare and Medicaid back then. They knew all too well what would happen – regulation and cost increases year after year…. Isn’t it amazing that our public trusted our physicians and hospitals back in the 1960’s and after decades of increasing governmental regulation and trillions of government expenditures healthcare suddenly fails to meet public expectations? It isn’t amazing that when you add insurance coverage to tens of millions that costs will increase? Not really….

Real Patient Lives vs. Corporatized/Government Healthcare, Part IV

The insurance and government dominated system is failing our patients. A physician friend of IP4PI shares this shocking example about the system claiming another victim:

A 59 y/o man presented to my last employed practice, with an almost elephantiasis swelling bilateral legs.  He had pinpoint marks on the skin of his legs.  He held up a jar with what looked like a couple of tiny maggots.  He said, these come out of those holes every so often.  I said how long has this been going on??  He said 1.5 years.  “I’ve mentioned to several doctors, they just shrug and don’t do anything.”  I said we would do something, and called the hospitalist immediately to admit for workup and treatment.  I was directed to the nurse gatekeeper for approval for admission.  What’s wrong, she asked.  “4+ edema in both legs, which are also full of maggots.”  Hmmm, she said.  There is no medicare admissible diagnosis of ‘maggots in legs’.  What about his rising creatinine of 1.7?  Not bad enough to qualify under guidelines.  Call us back if it gets worse.  I did try to do some outpatient workup, but I think the man was disgusted.  He never followed up.  He was dead within the year.