Birthday Presence and the American Flog- A Time for Bold Acts

My birthday tomorrow will be spent in service of my patients by day and training on a new super high-tech laser by night. Throughout my life I’ve made such choices that are not the most fun and most often are the last things I want to endure at the end of a busy day. I might grumble, “I’d rather be flogged!” as I forego the birthday dinner for the laser course, but, like most physicians, I have this inherent, unquenchable thirst to help patients, which requires we constantly improve, and give them our all, every last drop. Sadly, not a day goes by in clinic now that I am not fighting back tears, as my patients and I discuss the atrocity, insanity and reality of gargantuan federal healthcare law that is sucking the life out of the patient-physician relationship, the profession of medicine, and me. I am at a breaking point. The words demoralized, disheartened, and devastated are not strong enough. What will I choose to do about this?

I am not a quitter or an enabler, and I most certainly will not violate my code of ethics and betray my patients, as is required on October 1, 2015. This date is “Do or Die Day” for the federal government’s mandated use of ICD-10 codes to be able to bill government or private insurance companies for services to patients. Therefore, in a mere 9 days, I choose to practice completely 3rd party free. There is no other choice.

The response to my decision has been mixed. Those who value the patient–physician relationship, the Hippocratic oath, the great history of American medicine, individual freedom, patient choice, and personal responsibility support me. Bold physician leaders are forging new paths to practice medicine that retain physician autonomy and salvage patient privacy and dignity at a fraction of the cost by dealing directly with patients unconstrained by third party regulation, restriction and waste. Exemplary groups like the Association of American Physicians and Surgeons (AAPS) led by Dr. Jane Orient, Surgery Center of Oklahoma led by Dr. Keith Smith, Atlas MD led by Dr. Josh Umbehr, and a multitude of other pioneering entities provide incredible resources and serve as my models, inspiration and sources of courage to achieve this transition. The vast majority supports my move.

On the other hand, those who think the American people are stupid and incapable, those who seek single-payer socialized medicine, and those like Obamacare architect, Ezekiel Emanuel, who believes the Hippocratic Oath is outmoded, innovation too expensive, and that government must intervene with the patient-physician relationship, seek to castigate and denigrate those like me for daring to defy their top down diktats. I have been accused of “abandoning my patients for money”, which is a joke as my revenue will soon decrease when many of my patients leave me for different doctors who accept their insurance. The doctors who keep playing this game, implement, and comply with the central planners’ control of medicine the best will be the ones paid the most. I’ve been told that maybe I shouldn’t be practicing medicine at all, that I’m too old-school, because I won’t adopt the nonsensical, wasteful ICD-10 billing codes and government designed “meaningful-use” (classic use of Newspeak) electronic health records, which are interoperable with government and grant full access to patients’ medical data to be sold and shared with any entity the HHS Secretary deems appropriate. The charge that I shouldn’t practice medicine, because I’m an old school non-adopter is laughable as well; in fact, throughout my career I have been and continue to be an early adopter of the most innovative technological advances, as epitomized by spending tomorrow training on a new laser. My litmus test for “implement and comply” is twofold: 1. Does it serve the patient first? and 2. Is it the best use of resources? I invite these critics to my O.R., and I put our technology, facilities, professional staff, and outcomes up against any in the world. I then invite these critics to evaluate their relationships with 3rd party controlled, ICD-10 billing, “meaningful using”, data-collecting, in-network doctors du jour who must robotically follow government rubrics in order to be paid and publically scored for doing what the Secretary of HHS (a non-doctor) says.

Many of my patient-physician relationships span 2 decades of care and include 4 generations of family members. Many of these patients will stay in my care, I pray. But, the system is convoluted and confusing. Patients must be educated to understand what is going on. In many cases, it is more expensive to use health insurance than direct pay. My fees will be transparent and may cost less than most 3rd party fees. Most plans now have huge premiums, deductibles, and co-pays. For some patients for some services, my fees will be less than the copays. For most, even my surgical fees are far less than deductibles. Patients can deal with their private insurers depending on the particular “out of network” benefits of their plans. Physicians must educate patients, who have been subjected to 3rd party propaganda and marketing ploys, about the real costs and restrictions of 3rd party control of their healthcare. Communication is key.

Clearly, coverage is not care. As patients, we have spent our lives paying into Medicare and are now mandated to buy government-prescribed health insurance that is proving to be not affordable, not individualized, not easily accessible, and not best quality care. Many patients feel cheated, lied to, and angry. One reaction is to blame this on the doctors. We are on the front line of patient contact. We have been lied about and vilified by President Obama from day one. We are there face to face with patients when insurance companies hike rates, delay and deny care, and frankly mess up. We are there when patients are sick, scared, frustrated, and fed up. Consequently, more patients are filing more complaints and false allegations about physicians with state medical boards and consumer protection agencies when, in fact, the physician was trying to help the patient and was not the root of the problem. We are there for the flogging- left to defend ourselves, guilty until proven innocent, or else. This is when you really just want to throw in the towel and walk away.

As October 1st approaches, my heart flutters somewhere between exhilaration at the prospect of the ability to once again freely practice the patient-centered medicine of Hippocrates out from under the 3rd party boot, trepidation at the prospect of going completely out of business at what should be the pinnacle of my career, and a heart-stopping sorrow at the reality of losing so many of the precious, sacred relationships with patients that have been cultivated over the past 20 years. That hurts the most. The patients may leave me; I’m not leaving them. Patients and doctors must get educated, educate one another, and stand by one another if we are to survive all this. I hope my own oncologist, physicians, and surgeons don’t throw in the towel. They know me. We have something together that has value. I need them. I will happily pay them a fair, transparent fee. They’re worth it.

As I seek strength and wisdom through this, I am drawn to the apostle Luke, because he was a physician. Luke wrote the Book of Acts, which speaks to me about physical healing, spiritual healing, and salvation. It speaks about serving others through the presence of the Holy Spirit. Acts Chapter 4 and 5 are shouting at me.

Acts 4:8,9 “Rulers and elders of our people, are we being questioned today because we’ve done a good deed for a crippled man?”

Acts 4:13 The members of the council were amazed when they saw the boldness of Peter and John, for they could see that they were ordinary men with no special training…”

Acts 4:19 But Peter and John replied, “Do you think God wants us to obey you rather than him?”

Acts 4:21 The Council then threatened them further, but they finally let them go because they didn’t know how to punish them without starting a riot. For everyone was praising God for this miraculous sign- the healing of a man who had been lame for over forty years.”

Acts 4:29 “”And now, O Lord, hear their threats and give us, your servants, great boldness in preaching your word.”

4:30 “Stretch out your hand with healing power; may miraculous signs and wonders be done through the name of your holy servant Jesus.”

4:31 … Then they preached the word of God with boldness.

4:32 All the believers were united in heart and mind.”…

Acts 5:29 …Peter and the apostles replied, “We must obey God rather than any human authority.”

Acts 5:40 “…They called in the apostles and had them flogged.”

5:41 The apostles left the high council rejoicing that God had counted them worthy to suffer disgrace for the name of Jesus.”

Lord God,

I pray for the continued blessing of the freedom and ability to do good deeds for others, to serve them, and heal them. Help me be bold and obey you, even though I may be threatened and spiritually flogged. Thank you that I am worthy to suffer. I pray patients will see the truth and choose to stay with their physicians in meaningful long-term relationships that are focused on doing what is best for the patient with privacy, dignity, compassion, and mutual trust. As a people, may the Holy Spirit abide in our presence giving us strength to obey you, act boldly, and unite in heart and mind. Amen

Dear Daughters…

My 4th daughter just called me from college. We laughed, cried, and commiserated. I miss her. So bitter sweet. I raised her up strong and equipped to go. She went- just like she was supposed to. God blessed me with 4 daughters; now 27,25,22,and 18; together they have given me 92 cumulative girl years of mothering and great joy. Each is unique, and each part of an intricate, detailed family puzzle that is complete only when all these unique pieces are interlocked into the overall portrait of life. I am the table upon which the puzzle is put together. I dug up this old “Words of advice” letter to my second daughter, who is now a medical student and married. Thanks go to her high school GT English teacher Ms. Jan Ross for the assignment over six years ago. Our country is weary now from the divisiveness and fundamental transforming of what makes America great that has been going on nonstop in these 6 long years. I am weary. But my hope lies in these young women who will carry the torch of freedom and exceptionalism into the next generation. While much has changed, my advice to them hasn’t. I submit to them once again my twenty top tips for a young woman starting college. Dear Daughters…

Sunday, May 03, 2009

Dear Heidi,

Hamlet is the last of Shakespeare’s works you will study in high school, so it is only fitting that I offer you some words of advice as you prepare to leave for college, just as Polonius offered his famous advice to his son, Laertes, as he prepared to leave on his travels; “To thine own self be true”. In your case, Heidi, I whole-heartedly concur with Polonius, because you are a good, moral, and strong Christian lady of character, depth, and purpose, and being true to yourself is, therefore, a sound and good principle. If, on the other hand, you were a selfish, shallow, immoral, ungodly person, this advice would result in imminent self- destruction. I am so unabashedly proud of you and love you so much that words on this paper are not enough; it is beyond description and beyond your comprehension- until the day you are blessed with your own daughter of your precious composition. God truly blessed me with you. Some of this advice you have heard over and over, some has been implied without saying, and some is passed down from your ancestors through me to you. This advice will also be focused on leaving for college and starting your adult professional life; you will get the marriage advice later (I hope in at least four or more years from now!). Here are twenty top tips:

I. Have your priorities straight. 1.) Faith, 2.) family, 3.) future (education and profession), 4.) friends- in this order. Never stray from this.

2. Always do the right thing: seek truth and justice, and never, ever do anything illegal, ungodly, or immoral. Do not be afraid to suffer the consequences of this at times; it will always pay off and keep you on the right path.

3. Identify your God- given talents and cultivate them to his glory unceasingly. Live your life as a shining example of the miracle of God’s love and forgiveness. Identify the talents and goals, initiate the plan, and persevere.

4. Work hard/ play hard- NEVER, EVER MISS CLASS- I promise this is crucial- and do not be tempted to sleep in or procrastinate. Study hard and time-manage (you are already well-trained in this). Get up one more time than you fall. Make it look effortless. Then, make sure to have some fun, and in your down time, put your worries aside and PLAY HARD!!!! Study hard and long. Learn everything you can. View your education at The University of Texas as a privilege and an opportunity of which you must make the absolute most- and, wow, in a great city in the greatest state in the U.S.A., what fun!

5. Seek balance. You must balance all aspects of your being- feed your needs- spiritual, intellectual, physical, and emotional. Your primary purpose in college is to study and develop your intellectual aspect, but this best done in balance with all other aspects .Go to church, pray, sing and worship. Go to the gym, work out and do something physical each day. Get some sleep. Eat healthy. Tend your sheep- maintain relationships with your family and friends, and your true love-or you will lose them…and then you will lose yourself…

6. Keep your inner child alive. Have fun, laugh at yourself, plot and plan, scheme and dream, dress up, make cookies, cupcakes, and cakes, play games, take some risks, THINK OUTSIDE THE BOX, respect your elders/ educators, but question them- ASK WHY, come up with a better way, be innovative, creative, and don’t be afraid to color outside the lines. This is what leads to new discoveries, paradigm shifts, and a better future. If not you, then who??? Remember- you are not a dunce. You are a top 1%er- now and forevermore.

7. Do not surrender your individuality and the blessing of freedom. Fight for freedom of thought, freedom of religion, free speech-PRAY- pray morning, noon, and night, about everything and everyone. Limit government and empower the individual. Remember-you are not a drone. Stand for our country and its founding principles. Seek a moral society. Do not be complacent. Be courageous. Politically correct is often morally incorrect. Do not be oppressed.

8. Never, ever react to or respond to anything without waiting 24 to 48 hours. Always give thoughtful consideration, find out the facts, separate fact from fiction, sleep on it… Then respond. Be slow to anger. Today’s crisis is tomorrow’s comedy. Speak when you are angry, and you will make the best speech you will ever regret. If you are patient in one moment of anger, you will escape a hundred days of sorrow. Turn stumbling blocks into stepping stones and lemons into lemonade. After time has elapsed, respond-offer a solution-not just a restatement of the problem. Take a stand when necessary; it is your duty.

9. Be a victor, not a victim. While you cannot always control your circumstances, you can control your reaction to them. Take control. Be positive. Be a problem solver. Be a leader and a role model. Be accountable for your own words and deeds. See the glass as half full not half empty. Have a positive attitude. Believe in miracles.

10. Don’t rest on your laurels.

11. When it seems more than you can bear- remember, you can stand on your head for that long.

12. Be loving, kind, and courteous. Honey catches more flies than vinegar. Remember people’s names and find the best in them. Ask about them and their lives rather than talking about you and your life. Be humble. Listen and love. To have a friend, you have to be a friend. Reach out to others, don’t sit back and wait until they reach out to you. Help others. Give hugs. Bake more cupcakes.

13. Make a comfortable nest- a safe haven where you can curl up, clean, comfortable, warm, safe and sound with a cup of hot tea, a soft blanket, good music, and a good book.

14. Do your hair, wear makeup, and wear clean, decent clothes, even when you are really tired; this shows others you respect yourself and others. Set the example, have some pride in your appearance, and take care of your body-God’s temple.

15. Read The Bible daily, refer to the Declaration of Independence and The Constitution often, Have these in your nest along with a dictionary, Thesaurus, computer, and at least two really good books in progress. (Currently I am reading A Miracle That Changed the World The 5000 Year Leap Principles of Freedom 101 by W. Cleon Skousen and A Heartbreaking Work of Staggering Genius by Dave Eggers.) I like to have one nonfiction and one fiction going at all times.

16. You can laugh about it or cry about it- so why not just laugh. Smile and laugh as often as you can. It is therapeutic. Let water go over the dam. Don’t sweat the small stuff. Don’t make a mountain out of a molehill. Don’t worry about what may never and most likely never will happen, instead stop to smell the roses, don’t miss the forest for the trees- don’t miss sharing the love and fellowship of Christmas Eve with family, because you’re still out shopping for the last few gifts; it’s about your presence not the presents. And Carpe Diem.

17. Remember- You are always loved no matter what. God loves you, and I love you unconditionally. Jesus gave his life for you, and so would I. Your sisters, your dad, and I love you. We are your BFF’s, and we are just a text, call, or email away! We could all meet you half way for a group hug in about thirty minutes!!!! And we will!!!! You can be home in just over an hour!!! And you will!!!

18. Obey the 10 commandments, live the Sermon on the Mount, and possess the fruits of the spirit- love, joy, peace, patience, goodness, gentleness, and self- control.          Knock and He will open doors for you! Make sure you go in.

19. I have raised you for this time in your life since you climbed off my lap and took your first few steps on your own, and you are well-equipped and ready! Remember to freely and sincerely say “I love you!”, “I am sorry!”, and “will you forgive me?”. Don’t underestimate your potential, don’t be too self-critical, don’t be afraid, and do fulfill your destiny. You can do all things through Christ who strengthens you. Now, it is your turn to go out there and make your own family and your own life, for yourself, just exactly as you want it. But- you will always be part of this family, your God-given family, your birth family, your nuclear family, one of the sisters; you will always be my precious angel, and this will always be where you come home to. Make the world a better place and never give up. This is your calling.

20. Speaking of calling…. Call your mom every single day, more than once a day, email, text, and never forget she loves you and wants to know what you are doing every second of the day and that you are safe and well. You are what she lives for, and she can’t wait to see and experience all the amazing and wondrous things you will be and do. (I love writing about myself in third person.) Hook ‘em Horns!

Love,

Kris (Your MOM)

Letter my remaining private insurance patients will receive as I am forced to forced terminate all 3rd party agreements as of October 1- the day HHS mandates ICD-10 implementation

September 13, 2015

Dear Cherished Patient,

I most humbly request you take a few minutes to read my heartfelt letter to you. Whether I have cared for you for the past 20 years or you are new to the practice, I want you to understand that I value our relationship most highly and regard my service to you as your physician and surgeon as a privilege and a blessing. I honor the Hippocratic Oath and will treat you individually to the very best of my ability with dignity and privacy.

In 1965, President Lyndon Johnson signed the Social Security Act Amendments into law creating Medicare and Medicaid with the promise that the federal government would not interfere in any way with the practice of medicine whatsoever including compensation, administration, or operation of any institution, agency, or person per Title XVIII SEC.1801. In 2010, President Obama signed the Affordable Care Act with the promise, ”If you like your doctor, you can keep your doctor. Period.”

Tragically, over the past 50 years, the government’s pledge to not interfere with the practice of medicine has been broken. The law has been unheeded and continuously altered, such that the practice of medicine in the United States has been fundamentally transformed, commandeered, and all but lost. Your right to keep your doctor has been lost as well. My right to freely practice medicine has been lost as well.

October 1, 2015, the Department of Health and Human Services of the Executive Branch of the United States federal government requires that in order to bill for services physicians must implement ICD-10, the 10th revision of the International Classification of Diseases and Related Health Problems, a medical cataloging system of the World Health Organization that includes 141,000 diagnosis and procedure codes including W56.22 Struck by Orca, initial encounter, V91.07 Burn due to water-skis on fire, V97.33 Sucked into jet engine, X52 Prolonged stay in weightless environment, V95.40 Unspecified Spacecraft accident injuring occupant, and even VO6.00xA for when Grandma gets run over by a reindeer. The costs of ICD-10 implementation are staggering, far outweigh any perceived benefit, and are a vital factor separating financial sustainability from bankruptcy for private medical practices going forward. ICD-10 implementation was fought vehemently and delayed 2 years, but ultimately, money from lobbyists representing hospitals, IT (American Health Information Management Association), and other special interests bought votes and trumped the best interests of America’s patients and physicians. ICD-10 is required for all health care providers, billing agencies, clearinghouses, and payors that transmit patient data electronically (all HIPAA covered entities), not just Medicare and Medicaid.

Government is now virtually extorting physicians in unprecedented fashion. If physicians do not precisely follow government rubrics and implement and comply with everything the Secretary of Health and Human Services says, we are penalized. I am not implementing ICD-10, because it is nonsensical and doing so does not serve my patients first and is not the best utilization of resources. If I implement this nonsensical, wasteful system, what won’t I do? This is my line in the sand. Therefore, as of October 1st, I will be unable to submit claims for my services to you to your insurance company, because they will be rejected. I will be forced to terminate my agreement as an “in network” provider with your insurance company.

Just as government has broken its pledge not to interfere with the practice of medicine, it has broken its promise to you, the patient. On April 16,2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and soon government will be implementing Alternate Payment Models and Merit-Based Incentive Plans for physicians that are perversely incentivized, such that doctors who follow marching orders from the Secretary of HHS (a non-doctor appointed bureaucrat) will be rewarded monetarily and with a high, publically posted “Composite Performance Score”; those who do not do her bidding so well will be penalized. Further, if less money is spent on patients, more money is retained to profit the entities that ultimately pay, and thus control, physicians. Initially this will apply to Medicare patients but will be expanded to include all third party insurers. Think about it- we now have a system whereby you are forced to buy what amounts to prepaid “healthcare” from an “insurance” company that profits by restricting and denying the very care they are paid to provide. You have to pay them. They keep more money when they provide you less care.

Government has betrayed us, but we must not betray one another. The preeminent, inviolable relationship that must be preserved exists between patient and doctor. The insurance company-customer and government-subject relationships are secondary by great orders of magnitude. I am asking you to continue in my care. I will provide you with a transparent fee schedule that is fair, reasonable, and in many cases less than Medicare. My services may cost less than those of your hairdresser, mechanic, or any other professional with whom you do business.

Of utmost importance is your understanding of the convoluted healthcare system in which we are forced to live. Education and communication are critical for us going forward. Our premiums, deductibles, and copays have sky-rocketed. Our access to and networks of hospitals, doctors, and medications have been severely restricted. You will be pleasantly surprised, and in the long run you will be better served by staying in my care- outside of the restrictions and wastefulness of your insurance plan. For example, if your copay is $70.00, it costs you only $15 more to stay with me for your follow up exams. If your deductible is $5000.00, and your insurance company has negotiated “allowables” with surgery centers for cataract surgery or other operations, you will find my fees to be lower and you will save money to the tune of thousands of dollars. You will spend more using your insurance in many cases. Most importantly, you will not be subjected to what I call the “insurance shuffle” where each year you will have to start from scratch with a new “in network” insurance doctor du jour who knows nothing about you or your medical history and will spend but a few impersonal, data-collection-focused minutes with you. If you stay in my care, you can remain confident and comfortable in an ongoing, lifelong patient-physician relationship of mutual trust and respect. There is unquantifiable value in the patient-physician relationship that is focused on what is best for the individual patient as opposed to dealing with a third party controlled doctor who must enter meaningless data into government mandated electronic medical records that will be shared with “authorized users” who will have full access to patients’ private medical records. Guess who will have acces to your “confidential records”- “a provider of services, a supplier, an employer, a health insurance issuer, a medical society or hospital association, or any entity that is approved by the Secretary of Health and Human Services as determined by the Secretary.” I will put you and your well-being first, in place of nonsensical, if not harmful, government rubrics that serve the collective good and political ruling class at your expense. I will keep your personal medical information confidential and share it with no one without your consent. I will not violate my pledge to you. Please, stand with me.

If you chose to stay with me, you can personally file a claim with your insurance company for my services as an “out of network” provider. You, an individual patient, are not mandated to use ICD-10 codes. You are paying the insurance company; the company must deliver what it promised to provide. If you like your doctor, you apparently must now fight to keep you doctor. I pray you will. If you leave, I pray you will come back.

My choice is to violate my code of ethics and implement government–mandated ICD-10 and all other subsequent diktat or to terminate agreements with insurance companies and serve my patients first. I cannot continue to enable this perverse, wasteful, dysfunctional system. I pray you will work with me in a new paradigm-shifting, alternate universe where you have an actual doctor and actual medical care in lieu of government-mandated “insurance” that comes with neither. Enclosed you will find my fees. My staff and I are available to answer your questions and address your concerns. I appreciate your time and consideration of this critical matter.

Warmest Regards,

Kristin S. Held, MD

Letter my Medicare patients will receive as I am forced to opt-out October 1 the date CMS mandates ICD-10 implementation

September 13, 2015

Dear Cherished Patient,

I most humbly request you take a few minutes to read my heartfelt letter to you. Whether I have cared for you for the past 20 years or you are new to the practice, I want you to understand that I value our relationship most highly and regard my service to you as your physician and surgeon as a privilege and a blessing. I honor the Hippocratic Oath and will treat you individually to the very best of my ability with dignity and privacy.

In 1965, President Lyndon Johnson signed the Social Security Act Amendments into law creating Medicare and Medicaid with the promise that the federal government would not interfere in any way with the practice of medicine whatsoever including compensation, administration, or operation of any institution, agency, or person per Title XVIII SEC.1801.

Tragically, over the past 50 years, the government’s pledge to not interfere with the practice of medicine has been broken. The law has been unheeded and continuously altered, such that the practice of medicine in the United States has been fundamentally transformed, commandeered, and all but lost.

October 1, 2015, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services of the Executive Branch of the United States federal government requires that in order to bill for services physicians must implement ICD-10, the 10th revision of the International Classification of Diseases and Related Health Problems, a medical cataloging system of the World Health Organization that includes 141,000 diagnosis and procedure codes including W56.22 Struck by Orca, initial encounter, V91.07 Burn due to water-skis on fire, V97.33 Sucked into jet engine, X52 Prolonged stay in weightless environment, V95.40 Unspecified Spacecraft accident injuring occupant, and even VO6.00xA for when Grandma gets run over by a reindeer. The costs of ICD-10 implementation are staggering, far outweigh any perceived benefit, and are a vital factor separating financial sustainability from bankruptcy for private medical practices going forward. ICD-10 implementation was fought vehemently and delayed 2 years, but ultimately, money from lobbyists representing hospitals, IT, and other special interests bought votes and trumped the best interests of America’s patients and physicians. CMS could delay this but chooses not to.

Government is now virtually extorting physicians in unprecedented fashion. If physicians do not precisely follow government rubrics and implement and comply with everything the Secretary of Health and Human Services says, we are penalized. I am not implementing ICD-10, because it is nonsensical and doing so does not serve my patients first and is not the best utilization of resources. If I implement this nonsensical, wasteful system, what won’t I do? This is my line in the sand. Therefore, as of October 1st, I will be unable to submit claims to CMS for my services to you. I will be forced to opt out of Medicare.

Just as government has broken its pledge not to interfere with the practice of medicine, it has broken its promise to you, our nation’s seniors. On April 16,2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and soon government will be means testing you and charging you increasingly higher monthly premiums for your Part B Medicare.

Government has betrayed us, but we must not betray one another. The preeminent, inviolable relationship that must be preserved exists between patient and doctor. The insurance company-customer and government-subject relationships are secondary by great orders of magnitude. I am asking you to continue in my care. I will provide you with a transparent fee schedule that is fair, reasonable, and in many cases less than Medicare. My services may cost less than those of your hairdresser, mechanic, or any other professional with whom you do business. Of utmost importance is your understanding of Medicare Parts A, B, C, and D. Part A is the hospital part while Part B is the physician services part. You can still use your other parts of Medicare even if you choose to see me outside of Medicare Part B. You will be pleasantly surprised, and in the long run you will be better served by staying in my care outside of the restrictions and wastefulness of Medicare. I will put you and your well-being first, in place of nonsensical, if not harmful, government rubrics that serve the collective good and political ruling class at your expense. I will not violate my pledge to you. Please, stand with me.

If you chose to see me, government requires you sign an affidavit stating that you understand I have opted-out of Medicare and that you will not submit a claim for my services except for emergency or urgent care services.

My choice is to violate my code of ethics and implement government–mandated ICD-10 and subsequent diktat or opt out of Medicare and serve my patients first. I cannot continue to enable this perverse, wasteful, dysfunctional system. I pray you will work with me in a new paradigm-shifting, alternate universe where you have an actual doctor and actual medical care in lieu of government-mandated “insurance” that comes with neither. Enclosed you will find my fees. My staff and I are available to answer your questions and address your concerns. I appreciate your time and consideration of this critical matter.

Warmest Regards,

Kristin S. Held, MD