Letter to Senators-Physicians’ Asks-Fix the Doc Fix

March 30, 2015

Dear Senators,

March 26, 2015, H.R. 2, known as the “Doc Fix”, was passed in the House of Representatives with overwhelming bipartisan support. Ironically, the original intent of this bill was usurped in the name of compromise by members tacking on what can only be described as the “Fast-track to single payer”, thus rendering the touted changes to the SGR irrelevant. In this compromised form, the “Doc Fix” threatens to destroy the patient-physician relationship, the Hippocratic Oath, and the private practice of medicine in the United States of America. The Senate must not pass this bill in its current form. It must be corrected before being brought to a vote or not brought to a vote at all.

I spent the weekend reading the 263 page H.R.2 and remain beyond stunned that a Republican House that was elected to repeal Obamacare and maximize patient freedom and choice allowed such things as the MIPS (Merit-Based Incentive Plan System), Composite Performance Scoring of physicians (worse than grade school), complete access to confidential patient medical records by Qualified Data Registries (chosen by Secretary Burwell) that pay a fee to CMS for the data that shall be deposited in the CMS Program Management Account, and broadening the scope and power of the HHS Secretary were allowed to be put in this bill.

I do like SEC.106 that allows indefinite, continuing automatic extension of opt out election for physicians who choose to “Opt out” of Medicare, so that we no longer have to re-opt out every 2 years as presently required.

However, Section 507 is very troubling in this regard under current Administration behavior patterns. SEC.507 (4)(B)(i) gives HHS Secretary Burwell the power to determine whose National Provider ID(NPI) is valid. I can easily envision her invalidating NPIs for physicians who will opt out October 1,2015, effectively neutering us, because per this Bill, SEC.507(4) Section 1860D of the SSA is amended to require a valid NPI on Pharmacy Claims. Thus, those of us who opt out, will see patients directly and  prescribe indicated medications only to have the claim denied at point of service to the patient(507(4)(B)(ii), because the Secretary deemed our NPI invalid. She can selectively punish physicians with an opt out status and make it impossible for us to practice our profession, because of changes to the law in this bill. This and other features of the bill present serious potential traps which could result in restraint of trade for physicians.

Because H.R.2 was passed before we could read it, physicians can only rationally submit our “Asks” now to the Senate, now that the horse is of the barn for the House.

Here are 7 simple asks that must be placed in the Senate bill, or it must be defeated or not taken to a vote at all:

  1. The HHS Secretary must be prohibited from selectively invalidating Prescriber National Provider Identification Numbers from physicians once they have enrolled and received their unique NPI. SEC.507.(4)(B)(i) and (ii) must be struck from the bill.
  2. A Provider NPI number shall not be required in order for a prescription from a licensed physician to be honored. Physician licensure comes from each individual State, and any action by the Secretary to limit a State sanctioned license to practice medicine will be challenged to the Supreme Court level if necessary.
  3. Medicare, Medicaid, and SCHIP patients and/or their legal guardians must be guaranteed the right to refuse to have their personal medical records shared with data registries, government agencies, research groups, insurance companies, or anyone else via interoperable data transmission or any other method of sharing such personal and potentially damaging information. Patients will have to consent to such government intrusion per informed consent obtained by government agents not physicians or their overburdened staffs
  4. Physicians will be afforded an opt-out period (much like citizens are given an Obamacare enrollment period) that grants us immediate opt-out status on 10/1/2015 with the following terms:

-The physician can immediately opt out 10/1/2015 with the option to immediately opt back in at will if the law changes-such as Obamacare is repealed and replaced with a plan with terms under which a physician can morally and ethically practice, including but not limited to elimination of ICD10 and Meaningful Use 3 EHR mandates.

-The Provider NPI # cannot be invalidated and remains property of that unique physician.

-The Physician’s Part B opt out status cannot be used to deny a patient benefits or from utilizing his/her Part A,C,D Medicare because of the Part B status of the physician, whether it be participating, non-participating, or opted out.

  1. The Secretary of HHS will notify each individual Medicare (and Medicaid and SCHIP patients if Secretary includes them too, as she can do per this bill if she so chooses SEC.105.(b)((1)(B)(i) and (ii)) by letter signed by her, President Obama, Senate Majority and Minority Leaders, and Speaker of the House and House Minority Leader, which states that even though they like their doctor, they can’t keep their doctor, because the government will not allow his/her doctor to bill CMS as of 10/1/2015 without adopting the ICD10 system and MU EHR and submitting to rules requiring the physician to grant full access to the patient’s private medical record by data registries and others as the Secretary shall determine appropriate, and that his/her physician regards this as a violation of the Hippocratic Oath and breech of patient-physician confidentiality and therefore cannot morally or ethically comply with the government’s demands.
  2. The patient must be given a year to find a new government aligned doctor to their satisfaction; during this transition of care period, CMS must reimburse the patient in full for out of pocket expenses incurred, including payment made to their preexisting but now opted-out doctor.
  3. CMS will calculate and publish the number of doctors who opt out because of unreasonable mandates of this Bill that would require them to violate their conscience and the Hippocratic Oath, how many patients are affected, what specialties, what geographic regions, what socio-economic groups, and rural areas requiring lack of access to care (ie.,hour or more drives..), increased ER and urgent care utilization, and overall economic impact on HC expenditure.(This is actually in there and must remain SEC.106.(a)(2) and (5))

These are the “Asks,” and any physician who serves the patient under the principles of the Hippocratic Oath should concur.

I implore members of the Senate to scrutinize the bill to address these critical issues and modify or defeat the bill. Please, do not vote on the bill in its current state. If this bill becomes law in its current corrupted state, it forces physicians to betray our patients and our conscience, violate the Hippocratic Oath, and instead serve the government in order to be paid for our services, which cannot be compelled. We will have no ethical choice but to opt out of Medicare and Medicaid. Patients, particularly our nation’s seniors, will lose access to their doctors. We will lose access to our patients. The private practice of medicine in the United States of America will be extinguished.

Thank you for your consideration.

Respectfully,

Kris Held, MD

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Doctor, Fix Thyself

Government run medicine started in the U.S. with Medicare fifty years ago. The Medicare promise of 1965 bears little resemblance to the Medicare reality of today. Five years ago Obamacare was signed into law, and American medicine today is barely recognizable.

I have spent the last six years fighting the moral inversion of government run medicine and the incremental Orwellian implementation of Obamacare. I fight this mission to protect my patients, my profession, and my country.

Accordingly, I was on Capitol Hill this week presenting a practicing physicians’ plan for actual medical care solutions, offering a rescue plan for when the Supreme Court rules on King vs. Burwell, and defending my ability and autonomy to take care of my patients and practice my profession.

Obamacare forces physicians to betray our patients, violate the Hippocratic Oath, and serve the government hand that pays us.

Obamacare violates government’s promise not to interfere with the practice of medicine and physicians’ ability to care for patients that was made when Medicare became law.

Flashback to1965, Section 1801, Medicare Act:

“Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any institution, agency, or person providing health care services…”

Clearly the government has broken every word of the promise of this section.

March 26th, the House of Representatives passed H.R.2, a bill that increases the potential scope and magnitude of these crescendoing wrongs against the patient, the patient-physician relationship, and the practice of medicine as a whole.

The “Doc-Fix” bill was passed under the pretense of fixing the dysfunctional way government budgets the way it pays doctors. In reality, the bill was contaminated and serves to further statist goals of wealth redistribution and central control of one –sixth of our nation’s economy.

To pay for the “fix”, the bill requires that patients, who spent their lives paying for Medicare, will now be means tested, and the very people that put more in the system on the front end will now end up putting out more on the back end.

Also attached to the bill are Obamacare-derived requirements that doctors must implement an expensive, convoluted, government mandated electronic medical record, data collection, and billing and coding system or not be able to bill at all. If a doctor can’t bill, a doctor can’t be paid.

This system of billing and record sharing must be “interoperable” and will give “authorized users” complete access to patients’ health records. Authorized users include government officials, academic researchers, insurance companies and others besides health care providers. This violates the Hippocratic Oath at its very core, and virtually any single physician that goes along with this is put in an ethically untenable position.

How did this happen? While doctors worked away in the trenches, trusting that truth, justice, and our professional groups, such as the AMA, would prevail, lobbyists for hospitals, insurance, and IT pounded the pavement, spent obscene amounts of money, and rallied. This makes them big money and further puts government, with whom they collude, in control of even the most private, intimate details of patients’ lives. Such control is essential to achieve the desired Single Payer system that Obamacare supporters and players seek. This is the dirty little secret of the fix.

One Legislative assistant told us we were the first actual doctors to talk to him, while countless groups of lobbyists for hospitals and IT groups had inundated his Congressman’s office. Another Congressman, who opposes single payer and socialized medicine, told us he had never seen anyone from the AMA in his office in his 12 years in DC. (I would love to see who exactly the AMA lobbyists did indeed visit.)

Clearly, this is the wrong “fix”. Under the guise of fixing wrongs for doctors, if not attributing blame to us, blatant redistribution of wealth occurs, the once sacred patient-physician relationship is abducted, defiled, and laid bare for all to see, doctors are compelled to pay to play by government rules or not get paid at all, and most importantly, doctors will lose access to our patients.

A great irony is that this “fix” was brokered by, of all people, a physician member of Congress, apparently duped, outfoxed by Progressives once again.

Initially, I was devastated and tearful over the realization that I am at my “red line” and have no choice but to give up everything I have put together professionally in my life and start over from scratch- or sell my soul. But, I will not violate my Hippocratic Oath and patient-physician pact just so that I can be paid by unqualified central planners. I will not enable them. This is tough love time. They can take away every dime, pen, and phone, every provider number and insurance contract, but I will still have my mind, heart, soul, integrity, wisdom, knowledge, skills, experience, relationships, and faith- those they cannot take away. And that which they want and need, they do not themselves possess.

We physicians must forge a better way for our patients. This will be tough, but this is long overdue. So, instead of castigating my lawmakers, I thank them. I thank them for the kick in the rear to grow up and go it on my own as our Founders intended- free to heal, innovate, and prosper, free to enjoy life again, pursue my beloved profession freely, and to serve my patients individually with compassion, privacy, dignity, and love.

I pray my fellow physicians will open their eyes, realize what we are being told to do, and say “No More.” Government cannot do this without us. Their scheme is centered on the promise of our services-that they cannot compel. Without us- they can’t deliver.

We owe it to our patients and profession to make the hard call. We must set up an alternative universe, where patients can be seen by real doctors who they can trust, with confidentiality, at far less cost, without restrictions, and get real medical care. It’s time to stop being heeled and heal. It’s time to stand in defiance instead of defying our principles.

I pray our patients will stand with us. And I pray the Senate will stand against the bill in this contaminated form.

Letter from National Physician Coalition for Freedom in Medicine to Members of Congress

Fill in the name of your senator or house rep and send today!

Dear Senator/Congressman,

Practicing physicians across the United States have come together to draft a simple one-page plan outlining how we believe the federal government ought to proceed if the citizens of the United States are to continue to have access to the greatest medical care in the world without bankrupting the country. We have named our group the National Physician Coalition for Freedom in Medicine.

With the Supreme Court hearing arguments in the King vs. Burwell challenge to subsidies issued through HealthCare.gov, the pressing need for alternative legislation is apparent. As practicing physicians we offer credible alternatives.

The National Physician Coalition is meeting in Washington DC on March 25th and 26th, and we are respectfully requesting to meet with you to discuss our plan in person at your convenience.

We look forward to working with you and showing you what we have come up with.

Sincerely,

National Physician Coalition for Freedom in Medicine

Here is information regarding the meeting of our group- The National Physician Coalition for Freedom in Medicine. All physicians are invited, if not implored, to attend.

Dear Physician Colleagues,

Obamacare continues to wreak havoc. The decision by the Supreme Court to hear the King v. Burwell case in March creates a glimmer of hope. There is a real chance the Court will invalidate subsidies issued without statutory authority through federal exchanges. This would pull the rug out from under Obamacare, as some 90% of enrollees could lose their premium support. There have been many calls for Congress to prepare legislation to address this potential crisis, and to have it ready to go in June, when the Court decision is due.

We see this as a rare opportunity for a coalition of freedom-oriented physician groups to make our priorities known to Congress.

You are cordially invited to attend a meeting of the National Physician Coalition for Freedom in Medicine to be held in Washington, DC on March 25 and 26th. The limited goal of this meeting is to discuss, finalize and publicize a simple one-page plan to propose to Congress. We will focus on legislative items that will neutralize the worse aspects of Obamacare, and thus increase patient and physician freedom.

All practicing physicians who are concerned about the direction health care has taken are invited to participate.

AAPS has secured a meeting room and has preferred rates at the Cambria Hotel and Suites right in the heart of Washington, DC. We have chosen March 25 and 26, so ask that you save the dates, secure a room, and invite your colleagues. More details to follow.

Here is the link for hotel reservations. Ignore the error message and put in the dates to secure the preferred rate of $229 for this landmark event.

Space will be limited, so please register today by clicking here to fill out a short RSVP form. The form will also collect a $25.00 fee from each doctor (spouses and guests are free) to help cover the costs of this event.

Sincerely,

National Physician Coalition for Freedom in Medicine

Richard Amerling, MD, President, Association of American Physicians and Surgeons

Alieta Eck, MD, Past-President, AAPS

Ken Fisher, MD, Michigan

Arvind Cavale, MD, Pennsylvania

Craig M. Wax, DO, Independent Physicians for Patient Independence, New Jersey

Herb Kunkle, MD, Patient-Physician Health Care Alliance

Marion Mass, MD, PPHCA, Pennsylvania

Jane Hughes, MD, AmericanDoctors4Truth.org

Kris Held, MD, AD4T

Parvez, Dara, MD, New Jersey

John Tedeschi, MD, New Jersey

John Perry, MD, Pennsylvania & Florida

Marcy Zwelling, MD, California

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Send a letter to congress to help Physicians offer Congress credible healthcare alternatives

IP4PI - Independent Physicians for Patient independence

Fill in the name of your senator or house rep and send today!

Dear Senator/Congressman,

Practicing physicians across the United States have come together to draft a simple one-page plan outlining how we believe the federal government ought to proceed if the citizens of the United States are to continue to have access to the greatest medical care in the world without bankrupting the country. We have named our group the National Physician Coalition for Freedom in Medicine.

With the Supreme Court hearing arguments in the King vs. Burwell challenge to subsidies issued through HealthCare.gov, the pressing need for alternative legislation is apparent. As practicing physicians we offer credible alternatives.

The National Physician Coalition is meeting in Washington DC on March 25th and 26th, and we are respectfully requesting to meet with you to discuss our plan in person at your convenience.

We look forward…

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