Letter to my patients- 4 months working directly for you, not third party entities

February 29, 2016

Dear Esteemed Patient,

Innumerable things in Obamacare and the Medicare Access and CHIP Reauthorization Act of 2015  (MACRA)  place me in an ethically untenable situation such that I cannot go along with it any longer if I honor my commitment to serve you, my patient, not your insurance company or government agency. Accordingly, on October 1st, 2015, I terminated all agreements with 3rd party entities including Medicare and now solely enter into agreements directly with you, my patient. I work with you and for you. My pet peeve is when people say: “she doesn’t take insurance.” I look at it this way- I take YOU! I will do what’s best for YOU and help YOU use your insurance. I am delighted to see all patients regardless of insurance status. My staff and I will help you understand your insurance and help you file with your insurer for “out of network” benefits for my services if you so desire. You and I can discuss any and all aspects of your care. You will be pleased to find my fees transparent and affordable.

With today’s exorbitant copays, deductibles, and premiums, many patients find my new practice model more convenient, more affordable, and less restrictive than “in network” third party contracted models.  This includes Medicare patients. Many Medicare patients are delighted to find that when they see me, an “opted-out” or “private-contracted” physician, their secondary or supplemental insurance will cover anywhere from 20% up to even  %100 of the cost of my services in some cases. Even when it comes time for surgery, the cost for state of the art laser assisted cataract surgery and premium intraocular lenses may be less in my practice than in others that contract with Medicare. Each day we see patients with insurance whose copay is higher than the cost of my exam, depending on the nature of your visit. In some cases it costs you less not to file with your insurance than to use it.  I appreciate the opportunity to care for you and recognize you have made a choice to stay in my care. Thank you.

Now, time for a little history lesson. 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 XVII SEC.1801. Over the past 50 years, the federal government has broken this promise time and time again. The government takeover of medicine progressed under President Bill Clinton with the 1996 Health Insurance and Accountability Act (HIPAA) and the Medicare Sustainable Growth Rate ( SGR) via the Balanced Budget Act of 1997 empowering  Congress to control payments to physicians. President Barack Obama signed the American Reinvestment and Recovery Act of 2009 into law, enacting two hidden parts -the Health Information Technology for Economic and Clinical Health Act (HITECH) to “promote the adoption of meaningful use of health information technology” and  Comparative Effectiveness Research (CER) described by the government’s Agency for Healthcare Quality and Research (AHRQ) as “designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options.” In 2010, the “Patient Protection and Affordable Care Act”, Obamacare, became law. Last year, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) became law.

 

MACRA was publicized as the permanent “Doc-fix” rescinding the feared, but never implemented, SGR cuts, but in reality it expedites the transformation of patient-centered private practice medicine to single payer, government run, socialized medicine. MACRA establishes Alternative Payment Models (APMs), Merit-Based Incentive Plans (MIP’s), and Composite Performance Scores whereby government now completely determines how physicians are paid and penalized, and this is based on how well physicians implement and comply with government metrics. Physicians will literally be scored from 0 to 100 based on metrics established by the Secretary of Health and Human Services (a non-doctor, presidential appointee). Based on the Physician Composite Score, which is posted on the government website, physicians are paid more, the same, or less depending on how well they report their patients’ data per the Secretary’s mandates and metrics. This is the antithesis of what was promised when Medicare and Medicaid were enacted in 1965. Under the guise of lessening the burden on physicians, the Secretary of HHS is applying the quality metrics to all third party payers, private as well as government, facilitating transformation to single payer. The implementation of Obamacare and its “Fast Pass to Single Payer” companion law, MACRA, is disrupting the patient-physician relationship and the practice of medicine in the United States. We need a way to practice medicine outside this government domain.

Serving as another person’s physician is a humbling experience that is a privilege, a blessing, and a lifelong responsibility. The relationship is based on mutual trust. It is dignified, private, sacred and inviolable. I have devoted my life to acquiring skills, knowledge, experience, and wisdom while continuing to bring state of the art, innovative medical and surgical advances to my patients.

One thing I will not do, is violate my patients’ trust. I will not violate the Hippocratic Oath to my patients and profession as is required by the new payment models in Obamacare and MACRA. My life’s work will not boil down to cookbook compliance and data entry – doing what a politician wants instead of what my patient needs- to avoid being penalized or to get a bigger bonus from the government or insurance company. This is the ultimate conflict of interest.

I am beyond thankful for you cherished patients who have chosen to stay in my care. I have shed many a tear over those who have not. But, each of you- some of whom I have cared for over 20 years-will get personalized, state of the art, highest  quality, affordable care directly from me with no delays or denials from 3rd party interlopers into your medical care and without me having to divulge your personal information to strangers. I am no longer booked 3 months out- you can see me today! I am enjoying more quality time with my patients- those of you who choose to see me because you see value in our relationship over settling for a stranger on some insurance company’s list of “in network providers.” I will not seek an alternate career or retire early as are many of my colleagues. Instead, I’m working with like-minded colleagues to create an “alternate universe” where patients and doctors work directly with one another with mutual trust and confidentiality without 3rd party interference. We will be the paradigm shift. We will forge a new and better way. I look forward to going down that path with you.

Sincerely,

Kristin S. Held, M.D.

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How Do You Spell Insanity? G.O.P?

 

Albert Einstein is attributed with defining insanity as “doing the same thing over and over again expecting different results.” Accordingly, one can only describe this year’s Republican presidential primary season as insane.

The cast of the 2012 campaign season consisted of an expansive offering of exceptional candidates including, in alphabetical order, Michelle Bachman, Herman Cain, Newt Gingrich, John Huntsman, Ron Paul, Tim Pawlenty, Rick Perry, Rick Santorum, and eventual nominee, Mitt Romney. The defining issue of the 2012 campaign was Obamacare. Americans felt frustrated and betrayed by politicians of both parties. The Democrats had voted lock step with their leaders to make Obamacare the “law of the land” by reconciliation, against the will of the people, along strict party lines, amidst the perfect storm of single party control of the White House, House of Representatives, and Senate. The all-talk-no-action Republicans then failed to act on campaign promises to “Repeal and Replace Obamacare” after the 2010 midterm election swapped them for the pass-it-so-you-can-see-what’s–in-it House Democrats. It was all about Obamacare. After a brutal primary, former Massachusetts Governor Mitt Romney ultimately became the presidential nominee. Amazingly, from this impressive cast, the Republicans successfully nominated the only man in the world who could not launch an all out campaign assault on Obamacare, because he was in fact the father of its predecessor in Massachusetts, Romneycare.

He lost.

Barack Obama won reelection easily and proceeds full throttle with his fundamental transformation of the U.S.A. Having successfully infected us with Obamacare, Obama moves down his list of transformational action items. A key component of Obama’s second term agenda is his relentless refusal to enforce existing immigration laws, thus allowing millions of people from around the world to enter the United States illegally. Immigration now reigns supreme as a 2016 election issue, which brings us to this year’s cast of candidates.

The Republican primary season opened with 16 viable candidates. As Super Tuesday looms, five are left. It’s all about immigration.

Flashback to one year ago: I was in DC for a healthcare policy meeting on Capitol Hill as part of my ongoing (futile) struggle to get government out of medicine and preserve the patient-physician relationship. Our group was informed by a Republican leader that the 2016 GOP nominee would without question be Jeb Bush. I was stunned. Another Clinton-Bush election? Really? How out of touch with the American people could our elected representatives be?

There is no word to accurately describe how out of touch they truly are. The meeting turned out to be a heartbreaker, culminating in passage of MACRA (Medicare Access and CHIP Reauthorization Act of 2015) by the House of Representatives. MACRA was sold as the “Doc Fix”, a replacement for the despised Medicare Sustainable Growth Rate (SGR) passed under President Bill Clinton via the Balanced Budget Act of 1997, that empowered Congress to control payments to physicians. In reality, MACRA is a fast track to single payer socialized medicine and creates Alternative Payment Models (APM’s) and a Merit-Based Incentive Plan for physicians, whereby government gives physicians a Composite Performance Score from 0-100 based on how well they comply with government metrics and which determines whether they get a positive, neutral, or negative payment adjustment in the ultimate conflict of interests. It was supported by hospital and IT lobbies that stand to bank $Billions. Ironically, this bill (H.R.2) was introduced by a Republican Congressman from Texas, who is a physician no less, demonstrating the definition of “out of touch.” It bears mention that presidential candidates Senators Ted Cruz and Marco Rubio were two of only eight Senators to vote against this overreaching law.

Flash-forward to today: the American people have matured from feelings of frustration and betrayal to rabid anger and absolute mistrust of politicians. Jeb Bush will not be the Republican nominee. We the People are waking up. But, what about the leaders of the two political parties? They are becoming more and more indistinguishable. On February 24th, during a town hall on Fox News, John Kasich, one of the 5 remaining Republican candidates, outlined his plan to replace Obamacare for moderator, Megyn Kelly- and he regurgitated everything that is in MACRA to a tee. He proved he is a big government guy when he expanded Medicaid in Ohio, but this virtual recitation of MACRA qualifies him to run on Hillary’s ticket in the Democratic primary. Indistinguishible.

So who’s left?

In alphabetical order:

  1. Dr. Ben Carson, who has a stellar health policy as well as policy papers on all major issues including immigration.
  2. Senator Ted Cruz, a brilliant defender of the Constitution who has proven he will stand against the Washington cartel on everything from Obamacare to immigration.
  3. Senator Marco Rubio, who was part of the illustrious, one big party, “Gang of 8” on immigration.
  4. Billionaire reality TV star, Donald Trump, who says he will build a wall, get Mexico to pay for it, and “round ‘em up and move ‘em out.”

Who will the Republican Party back now that their pick, Jeb Bush, is out? Many predict they will, no doubt, begrudgingly support Senator Rubio-and only because John Kasich is too far behind in the polls.

If they do, once again, the GOP will back the only candidate who cannot defend his position on the number one issue of the presidential campaign. Like Romney/Romneycare was to healthcare in 2012, Rubio/Gang of 8 is to immigration in 2016. From every potential candidate in the world, could it be that the Republican Party will once again endorse the single candidate who can’t defend himself on the biggest issue? Will this self-destructive, out of touch party epitomize Einstein’s definition of insanity once again?

And lose. Again.

Now that we know how insanity is defined, how do we break the losing cycle? We must take bold action, vote for who we want to elect not for who they tell us is electable, and pray that Republican leaders actually get in touch with the American people, take a big dose of reality, and resist their urge to back Rubio this time around. We the people must spell this out for them loud and clear. If we do not, there is no doubt “Insanity” will forever be spelled: G. O. P.

 

Brave New Practice

The implementation of Obamacare and its “Fast Pass to Single Payer” companion law, MACRA, is disrupting the patient-physician relationship and the practice of medicine in the United States. We need a way to practice medicine outside this government domain.

My father is a retired neurosurgeon who inspired me to pursue a life in medicine, which he regards as the most noble profession. He taught me to honor the tradition, serve the sick, and advance the field. He taught me to study hard, work hard, and care for patients, each one to the best of my ability with deep commitment and compassion. Work toward perfection; there is no room for errors. Listen to them, examine them, and treat them according to the Oath of Hippocrates. Serving as another’s physician is a humbling experience that is a privilege, a blessing, and a lifelong responsibility. The relationship is based on mutual trust. It is dignified, private, sacred and inviolable. My father was a leader in his field, a teacher, an innovator, courageous, principled, and a hero in my mind. He taught me to be a strong individual, an innovator, an independent critical thinker, a problem solver, an ethical and moral person. He taught me the importance of truth and trust. I wanted to follow in his footsteps since I was a little girl in third grade and recognized I had the wherewithal to do so when I received both the academic award for the highest grades and the “R” award for responsibility in the fifth grade. I mustered the courage and pursued my calling.

I am a surgeon now. I built a practice of which I am proud. I have worked so hard that some days I would get tightness in my neck and could hardly breathe. At times, I regarded sleeping and eating as inconvenient intrusions into my schedule, especially when my four precious daughters were little girls. When I delivered each of my 4 babies, when I broke my leg and had two operations, and when I had breast cancer and had 3 operations, I never missed more than two weeks of work. I have worked two weeks overdue, two weeks after a C-section, two weeks after 8 screws and a plate, and two weeks after a mastectomy. I have worked in early labor, drains under my dress, in a cast, and from a wheelchair. I worked when my daughter was in the ICU. I do this, because it is my obligation to my patients and my profession. I love my patients. I think about them all the time, especially when they are not feeling well or something is not quite right. I became skilled, experienced, wise, and efficient while continuing to bring state of the art, innovative medical and surgical advances to my patients.

One thing I will not do, though, is violate my patients’ trust. I will not violate the oath to my patients and profession as is required by the new payment models in Obamacare and MACRA. These new models require me to submit government required “quality metric” data via interoperable electronic health records to virtually anyone the Secretary of Health and Human Services deems appropriate. MACRA literally creates a grading system from 0 to 100 for physicians, called the Composite Performance Score, which will be posted on the CMS website and will be used to monetarily reward, neutralize, or penalize physicians based on their score. The Secretary of HHS, a non-doctor political appointee, will literally choose and approve the so called quality metrics and other measures on which physicians will be graded. Those who best comply with what the HHS Secretary deems important will be paid more, while non-implementers and non-compliers will be paid less. My life’s work will not boil down to cookbook compliance and data entry just so I can earn a good grade from a Washington politician or grovel for a few more crumbs. Innumerable things in Obamacare and MACRA place me in an ethically untenable situation such that I cannot implement nor comply. I have written about this extensively at KrisHeldMD.wordpress.com .  Accordingly, on October 1st, 2015, I terminated all agreements with 3rd party including Medicare and now solely enter into agreements directly with my patients.

I am beyond thankful for those cherished patients who have chosen to stay in my care. I have shed many a tear over those who have not. Today I saw 32 patients instead of 50. Thursday I will operate on 6 patients instead of 10. But, each patient- some of whom I have cared for over 20 years-will get personalized, state of the art, quality, affordable care directly from me with no delays or denials from 3rd party interlopers into their medical care and without me having to hand over their personal information to 3rd party medical record voyeurs! I pray I will be able to build this direct patient care model  and stay in business in Ophthalmology, a surgical specialty where most of my surgical patients are of Medicare age. You see, I also have a young associate with whom I share 9 employees who depend on me for their jobs and a landlord who depends on the rent from my office space and so on.

I find it ironic, that at the pinnacle of my career when I am most proficient and efficient, when there is a shortage of doctors, and when patients are going without care, that because of the healthcare “law of the land”, I am seeing  25% less patients, doing 30% less surgery, and down-sizing. I am no longer booked 3 months out- you can see me today! But, I love it even more! I am enjoying more quality time with my patients, who choose to see me because they see value in our relationship over settling for a stranger on some insurance company’s list of “in network providers.” I will not seek an alternate career or retire early as are many of my colleagues. Instead, I’m working with like-minded colleagues to create an “alternate universe” where patients and doctors work directly with one another with mutual trust and confidentiality without 3rd party interference. I will be the paradigm shift. I will forge a new and better way.

My 2 oldest daughters are in medicine as well- third generation physicians. The oldest is a resident, and the second is a 3rd year medical student. While most physicians now discourage their family and friends from going into medicine, I am quite the opposite. I encourage the best and brightest to study hard, work hard, and pursue the humbling, blessed life in the noblest profession. God knows, we need good doctors.

I advise them to honor the Hippocratic Oath, serve their patients solely, and to never enter into 3rd party agreements with government or other 3rd party entities. Most of all, I could not bear to watch my extraordinary daughters squander their brilliant minds, hard earned skills, and beautiful souls clicking away on some lame government mandated EHR, their services compelled, reduced to mindless drones, implementing insanity and complying out of fear, thus enabling the demise of Hippocratic medicine and the rise of team based, population based health rationing replete with the politicization, if not weaponization, of medicine. That a partisan bureaucrat who may know nothing about medicine will give them a grade on how well they do her bidding, which determines their pay, is beyond distressing.  My comfort lies in the knowing that having traversed the rite of passage known only to those of us who have earned the title physician, we possess a shared, sacred knowledge that cannot be stripped from us. This we must hold dear. Together we will work together, ever vigilant, fighting to preserve our ability and autonomy to practice patient centered medicine in the United States of America- even if we must practice in an alternate universe. This is not easy, but nothing worth fighting for ever is. It starts here and now with me- in my brave new practice.

Time for Offense in the Game of Our Lives: Suit Up!

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 XVII SEC.1801. Over the ensuing 50 years, physicians and patients have done nothing but lose yardage in the ultimate game of life. The filthy rich, loaded-bench, goliath government offense relentlessly works the ball, trick plays, mid-game rule changes and all, toward their goal as our scrawny, dilapidated defense is blind-sided and beaten back time and time again. It’s 4th and nowhere to go as our backsides ram into the goalpost, which feels colder and harder,  like the headstone of American medicine that it is.

Team Goliath’s offense surged when President George Bush signed the Omnibus Reconciliation Act of 1989, enacting a physician payment schedule based on the resource-based relative value scale (RBRVS). Medicare RBRVS was implemented in 1992 establishing its infamous Relative Value Units (RVUs), which Medicare uses to decide how much it will reimburse physicians for their services. The AMA/ Specialty Society cheerleaders eagerly set up their Relative Value Scale Update Committee (RUC).

Team Patient-Physician mustered a defense and The Health Security Act of 1993, otherwise known as Hillarycare, failed to become law. The progressives countered back with a vengeance under President Bill Clinton with the 1996 Health Insurance and Accountability Act (HIPAA) and the Medicare Sustainable Growth Rate ( SGR) via the Balanced Budget Act of 1997 empowering  Congress to control payments to physicians.

President Barack Obama signed the American Reinvestment and Recovery Act of 2009 into law, thus enacting two hidden parts that furthered the statists’ assault on medicine-the Health Information Technology for Economic and Clinical Health Act (HITECH) to “promote the adoption of meaningful use of health information technology” and  Comparative Effectiveness Research (CER) described by the government’s Agency for Healthcare Quality and Research (AHRQ) as “designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options.”

They threw the long bomb in 2010, the biggest end-around, trick play in American history- the passage of the “Patient Protection and Affordable Care Act”, Obamacare. The goal line stand has since been a blood bath with team Goliath changing the rules  every down and playing dirty.

The ultimate trick play was the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)- sponsored by Rep. Michael Burgess, (R-TX-26 and an M.D., no less). MACRA was hailed as the permanent “Doc-fix” rescinding the feared, but never implemented, SGR cuts, but in reality it jettisoned the Goliaths to the win establishing Alternative Payment Models (APMs), Merit-Based Incentive Plans (MIP’s), and Composite Performance Scores whereby government now completely determines how physicians are paid and penalized, and this is based on how well physicians do what Goliath says. Physicians will literally be scored from 0 to 100 based on metrics established by the Secretary of Health and Human Services (a non-doctor, presidential appointee). Based on the score, which is posted on the government website, physicians are either rewarded, neutralized, or penalized monetarily based on how well they report their patients’ data in the name of quality metrics  per the Secretary’s command. This is the antithesis of what was promised when Medicare and Medicaid were enacted in 1965. To their credit and a testament to their courage and actual reading of the law, Senators Ted Cruz and Marco Rubio were two of only eight Senators to vote against MACRA.

The CMS Quality Measure Development Plan: Supporting the Transition to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) (Draft) is up on the CMS website awaiting comments by March 1st. It is a 61 page pathetic gameplan. They think they’ve got the win, that we’re in left field, and that this measure development plan will fly by without negative comments. Under the guise of lessening the burden on physicians, HHS will be applying all their metrics to all third party payers, private as well as government, in a legendary coup, punching it in for single payer.

But do they really have this in the bag? In their haughty haste, we must force a fumble, overtime, and ultimately a win for the patients.

The 50 year sustained defense has not worked. Our only option for survival is to mount an aggressive offense, and the two minute warning has almost ticked off . Not only have big government medicine proponents expanded their offense to include organized medicine, which profits bigtime, but they have gone to the States.

Here’s what they’re doing, and here’s what we must do. Physicians like me( who cannot ethically practice under MACRA, effectively droning away as an arm of big insurance, my services compelled by big government who says “do what we say to get pay or else”,  at the expense of the best interests, privacy, and dignity of patients) have said NO MORE! Growing numbers of us are severing all agreements with insurance companies including Medicare and Medicaid. They cannot provide what they promise without physicians. So, they are trying to end our ability to practice outside their grip.

  1. Direct Patient Care is the way we must go. Physicians like me set up fair, transparent fees and provide the best care directly to the patients outside the payoffs, waste, redundancy, restrictions, and regulations of the government-insurance cabal. Per Obamacare, patients are mandated to buy policies from companies who get billions of dollars from the patients and government subsidies. In the ultimate conflict of interests, the insurance companies (which are beholden to shareholders to profit) keep the cash by denying and delaying the care. Establishing restricted networks, called “in-network”, helps them do this covertly. While they deny they are rationing or withholding care, if they have too many patients and not enough doctors, the line is long, and the money goes out much slower, AKA they keep it. It’s like putting only one cashier at the return counter the day after Christmas. Patients can, however, choose to see “out of network” doctors like me and get the care they want and need expediently. To the surprise of most, my fees are often lower than their copays and allowables making it cheaper (including surgery) NOT to use their in network insurance with its associated exorbitant premiums, deductibles, and cost sharing which has exploded under Obamacare. Historically, patients then file with their insurance company for services from “out of network providers” and receive a check back from their insurer. To get around this, big insurance has set up separate deductibles for out of network doctors, decreased the amount they will cover, and in the case of Texas’ Obamacare Exchange plans (which Texas refused to set up, but the feds came in and did it against the will of the state) no out of network providers are covered at all. Team Goliath has gone full frontal now going to states like New Jersey and Florida and introducing bills to ban out of network billing altogether. Fortunately, these bills were defeated by the vigilant few. Physician groups like the Association of American Physicians and Surgeons (AAPS) through diligent work of expert counsel, Andy Schlafly, have been instrumental fending off such law. But defense is wearing down and Goliath has the momentum and the money.

We must mount an offense. In stark contrast to the big cabal quest to ban all out of network billing, we should propose legislation to Ban Restricted Networks!

  1. Hawaii recently introduced a bill to require physicians to see Medicare patients as a condition of getting a license to practice medicine in the state. This amounts to extortion, restraint of trade, theft of intellectual property, if not violation of the 13th Amendment in my mind. Sneeky players like the Federation of State Medical Boards (FSMB) and their pal Interstate Compact are going state to state under the guise of helping physicians get licensed in more than one state. Physicians are in reality licensed by their respective states. Maneuvers by the FSMB in effect usurp the state’s power of physician licensure and are potentially a stealth move toward national licensure.

We must go state by state and prohibit the FSMB and other such self-serving groups from trumping individual states, and we must prohibit individual states from compelling our services and linking our ability to obtain a license to practice medicine to requirements that amount to indentured servitude. We must pass legislation that affirms that licensure cannot be linked to compulsion of service to government, insurance, or other 3rd party entity.

  1. Groups such as the American Board of Internal Medicine (ABIM) are linking our hard earned, once lifetime specialty board certification to passing recurring tests they create and from which they then profit hundreds of millions of dollars. In epic irony, the ABIM head is actually named Rich Baron, M.D. Further, these physician-government colluders attempt to propagandize and indoctrinate us with what they want us to “study and pass.” MACRA makes MOC requirements part of the physicians’ Composite Performance Score, and the very people who develop the metrics, like Christine Cassel, M.D., head of National Quality Forum(NQF) are the very ones who profit from the MOC testing (Cassel is former ABIM head too). They charge us thousands of dollars to take their tests, AKA regurgitate government metrics and agenda items, and then score us-paying us more for doing their bidding and penalizing us if we don’t. Further, many hospitals require the sham maintenance of certification for us to obtain or retain hospital privileges.

We must create and support alternative boards composed of non-profiteering physicians with integrity, in stark contrast to the profiteers of the ABIM. Such exists in the National Board of Physicians and Surgeons led by Dr. Teirstein; we must sanction this. Most importantly, we must reassert that board certification is a lifetime achievement and remove maintenance of Certification (MOC) once and for all, especially from the auspices of the ABIM, bureaucrats associated with MACRA, quality metrics, and the ACA, and hospital credentialing boards. Join the AAPS with its proven record of fighting for the private practice of medicine and call out the AMA and other quasi-government groups who sell us out. Educate ourselves about corrupt and incestuous relationships of physicians like Christine Cassell, MD former head of both ABIM and NQF who plays a huge role in determining quality metrics- and then makes millions in cash and shares in companies for testing us on them.

  1. All patients and physicians must go on the CMS website and comment on the CMS Quality Measure development Plan by March 1st to stop the complete government control of patients’ medical care.

 

This is just a start, but we must do this. All of it. The clock is running out. Goliath is cocky and corrupt. We must find a way to get our patients and the practice of American medicine into overtime. Get off the bench. Suit up (and it will take literal lawsuits at the local and state levels and all the way to the Supreme Court, no doubt)! It’s time for offense in the ultimate game of our lives.