March 30, 2015
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:
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
Kris Held, MD