Yesterday, multiple news sources including the LA Times and the AMA Morning Rounds, reported that the USPSTF had deemed depression screening be done by general physicians for all patients. Read these pieces and the USPSTF report for yourself.
There is SO MUCH wrong with this on so many levels.
1. Depression and mental health problems plague Americans. As physicians, we love our patients from head to toe, heart, mind, and soul. As we learned in medical school, internship, residency, and a life in medical practice- we must examine and treat the Whole patient. We took the Hippocratic Oath, and we will not violate it. As part of our standard of care we “screen” our patients for depression as a natural part of what we do. We seek better access to mental health care and treatment for our patients 24/7. We DO NOT NEED a federal task force to tell us to do it; we do it on our own, because that’s what we’ve trained to do and devoted our lives to doing.
So, why is it a big deal if the United States Preventive Services Task Force (USPSTF) now looks at and gives a grade to “Depression Screening”? Because under Obamacare, the grade given by the USPSTF determines whether what they graded is deemed a covered service to be done for patients for free as a benefit of their Obamacare compliant/sanctioned/approved coverage. Well, if we do it already as part of our already covered yearly exam, why does it need a separate grade or category? Does government now regard physicians as so inept or so in need of specific instruction that a government task force must tell us what to do? Or is it something else, more insidious?
2. Obamacare architects and implementers did not and do not want to pay physicians for what we do. They want to change the way we are paid from “Fee for Service” to new Alternative Payment Models (APMs) in conjunction with Merit-Based Incentive Plans (MIPs), which were catapulted forward in last year’s MACRA law (which was passed under cloak of being called the SGR or Doc fix- but in reality replaced the dysfunctional SGR, PQRS, MU-EHR, etc… (that doctors hate) with what is far, far worse.) Now, under APMs and MIPs, physicians are paid and incentivized monetarily and graded publicly for how well we implement and comply with government rubrics.
Physicians (now lumped into a group of “providers” called “Eligible Professionals”) are then given a grade- called the Composite Performance Score- based on how well we do all that the Secretary of HHS has laid out in her rubric, and this score is posted on the web for all to see. SO- the USPSTF now pulls out “depression screening” as a separate service to be looked at for 1. link to pay and 2. link to performance score.
In order to be paid and scored higher, physicians must now PROVE to the government overseers that we did, in fact, do the depression screening. How do we prove that? By submitting patient data in the form of interoperable, Orwellianly-named “Meaningful Use” electronic health records. I have written about this since March 2015 when the MACRA scam went down. (Please see my April 2015 and thereabout blog at krisheldmd.wordpress.com). SO now, the NQF (National Quality Forum) and other government agencies, task forces, and committees subject to the HHS Secretary’s determination will make up quality metrics related to depression screening that we will have to specifically enter in/ click off in the patient’s medical record and submit to gov officials to prove we are worthy of our pay and determine our Composite Performance Score, which then determines whether we get a positive, neutral, or negative payment adjustment factor.
So now, government pays and grades physicians for reporting on patients’ mental health- all as a result of the USPSTF choosing depression as something to be looked at, graded, deemed a covered service, and linked to physician pay, reward, and penalization via MACRA and its MIPs and APMs. The current powers that be decide what should be looked at, studied, and linked to quality metrics in this way.
Anyone the Secretary of HHS deems eligible can have access to this information.
3. I for one read all this crazy healthcare law unfolding over the last 7 years. I saw this coming. I cannot ethically practice under this model if I honestly uphold the Hippocratic Oath and my oath to patient privacy and dignity. So, I can’t even file a claim with CMS or any 3rd party insurance. Presently, I am completely 3rd party free and engage in relationships ONLY BETWEEN MY PATIENTS AND ME. No one else gets access to these private medical records without the patient’s direct instruction or permission. Why is this so important?
4. It doesn’t take Sherlock Holmes to connect the dots from this single-payer loving, Obamacare creating, anti-2nd amendment, agenda driven administration to the USPSTF choosing depression to be graded using “quality metrics” and set forth as a covered benefit, which is then linked to physician pay and quality grade, which gives the Executive branch via HHS, ACA, HITECH, HIPAA, MACRA, and so on, direct access to personal patient data deeming a vast number of Americans depressed/AKA mentally ill, and ergo rendering our patients potentially unable to pass a background check to purchase a gun, obtain a CHL, and so on. This is beyond a slippery slope. That physicians so blindly and in sheep-like fashion forge ahead with reporting these “quality metrics” in the government sanctioned meaningful use EHR to grovel for a few more crumbs is beyond heartbreaking. Patients and physicians could shut this down in a minute by simply resisting-massive ,passive,peaceful resistance. BUT- does it all boil down to money once again? Will patients agree to virtually anything, including granting government access to their most private, intimate information in their medical record, in order to get what they perceive as “free care”? Will physicians now just collect and report virtually anything the government wants in order to get paid more? Wow, just wow.
Federal panel recommends general physicians screen all adults for depression
In a sign that the treatment of depression is shifting to the mainstream of American medical care, a federal panel has recommended that general physicians screen…
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