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.


Kris Held, MD


11 thoughts on “Letter to Senators-Physicians’ Asks-Fix the Doc Fix

  1. Kris,

    Very nice! Howzabout I blog this?

    Best wishes for good health,

    Dr. Craig M. Wax Family Physician/Host of Your Health Matters Rowan Radio 89.7 WGLS-FM http://www.wgls.rowan.edu Editorial Board of Medical Economics/Modern Medicine Independent Physicians for Patient Independence, @IP4PI on Twitter and FB HealthIsNumberOne.com

    • Rochelle Perrault-Stewart hugs to you too I’m trying to love me but it’s so hard spec. When I’m so embarrassed of my body I have 2 daughters and my middle daughter always makes me feel even more embarrassed spec cus of my illeostomy bag smells or it it blows out ,and when I get sick the smell is horrible specially with my fistulas cus when I get really sick i get a really gross discharge from them becus when they get infected they get like some kind of pus pockets around them and the discharge is this horrible nasty thick brownish looking stuff. It’s so hard cus she knows I cant do anything about it or the smells she even goes as far as gagging which when I’m sick like that the gagging noise makes me throw up even more . Because my bowel will get inflamed and will block off causing my fistulas to cause the nasty discharge and all that will digest thru my illeostomy is bile .I’ve cried myself to sleep at night so many times and u wld think she wldnt act this way it’s very hurtful and I’ve had my illeostomy bag for 18 yrs just over the past few yrs my fistulas have gotten worse and when i get sick like that I usally end up with sepsis ecoli and bad uti and kidney infections I’ve also have had my nerphrostomy tube and bag for bout 10 yrs and i only have my right kidney. I was diagnosed with stage 4 cervical and uterin cancer in may 2001 and in may of 2002 I had to be taken into exploratory surgery and we found out I was overdosed by my radiation internal treatments which fried my left urethra tube and eventually killed my left kidney and my bladder no longer works and the nerves in my lower back and pelvic area were also fried I eventually had nerophathy so bad I wld fall constantly and the cancer center here where I lived looked at me like I was crazy . Anyways I was basically their Guinea pig and I was the first cancer patient to try hyperbaric treatments to try and stop the radiation from eating away at my tissues . I also remember My radiologist crying at my bedside when I first woke up from the exploratory surgery she said this had never happened to a patient of hers b4 and my gynecologist is the one that left the radiation rods in to long. My radiologist ended up transferring to another town becus she felt so bad and I guess guilty .my gyno finally moved to another state a few years later. And when I started having issues with my bowel and fistulas were not to long after my gallbladder was removed that’s when I started having bad problems I was spending atleast 3to 4 wks in the hospital because from what I figured out was everytime I got an infection my bowel wld shut down causing me to get really sick and to throw up over and over this went on for about 2 yrs straight and the hospitalist excuse was it was blocking off because of my pain meds which I had been on for 16 yrs at that time and then in dec. 2017 i got very sick and the er never checked my lactic acid not even in the prior hospital trips and stays anyways i ended up coding and had to be put in a medically induced coma and on a ventilator and breathing tube for a week or so the icu didnt even contact my daughters.. and i barely made it off the ventilator they even forced a catheter in me knowing my bladder did not work and it was in my charts that i had a nerphrostomy tube and bag . And they didnt ever check the nerphrostomy tube at all it ended up blocking and i had to be transported, to another hospital and city 2 hrs away they didn’t notice i was layin in pee cus it was coming out my incision on my right side after all that was fixed I finally got to go home on Christmas eve just to end up back in icu because the catheter they forced in me caused a bad bacterial ecoli infection to where the nurses had to put on special gowns and I spent another cple .of wks in icu. So now they make sure they check my lactic acid levels which I was just in icu 2 wks ago with sepsis and ecoli and a bad kidney infection.. I’m so over always being sick and I’m also stuck in a wheelchair I have been for about 10 yrs cus the cancer center wldnt do anything in the previous years to help me and their excuse for me being overdosed by the internal radiation treatments is that I’m 1 in 15%that this happens too
      And ofcourse I cant sue because the statue of limitations was for 3 yrs even though this is still a big ongoing problem for me and now the government and state want to take away my pain meds that ive been on for 18 yrs spec because I get ohp plus /medicaid which they dnt cover my pain meds they haven’t for about 5 yrs now . Its really hard becus I need my meds to just have a lil bit of relief from the nerve pain and the pain in my insides. Its barbaric and inhumane what the government is doing to chronic pain patients. I will keep u in my prayers and please join the dont punish pain patients groups there all over in every state I think the government is doing this for population control and the CDC is actually saying they screwed up when they came out with their guidelines in 2016 but it’s a little to late and oregon just wants everyone off pain medication there has been so many suicides because chronic pain patients were forced off their pain meds and our drs are scared to treat us. I’ve been cut back way over half of what I used to get and having a illeostomy bag meant they had to shorten my digestive tract so my meds only stay in my system for about 2 hrs and I have to chew them up if I dnt they come out whole in my bag. And I cant take aspirin ibuprofen advil motrin or lyrica or anything with aspirin in it and I am immune to almost all antibiotics but I think 2 now.. sorry to basically tell u my life story for the last 18yrs I do have 2 really awesome drs that have been with me from day 1 of all this nightmare.. I guess I will just be alone the rest of my life but I have god watching over me and hes keeping me here for a reason wish I knew what it was cause I wld have rather died when my son was killed 8 yrs ago so my son cld live his life but some reason god keeps me here.. plus I’m very stubborn and dnt give up easily though there are and have been days I wish I wasnt here..

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