Physician Patient

Archive for April, 2016

ACA Whoppers

Friday, April 29th, 2016

MPPA applauds the desire of HHS Secretary Sylvia Burwell to trust her doctor. She says she wants her physicians to be paid to help her get quality, person-centered medical care. And she correctly notes that in 2016 government and private payers do not pay doctors for patient-centered health care, and that today most physicians are overburdened by third party care rules including coding for pay and burdensome clinical record documentation requirements.

Burwell’s desire is to pay doctors for the best care they can give to patients. But the proposed “Quality payment Program” she is promoting actually bypasses patients and families as the critical judges of their personal health care quality. Rather than trusting patients, the federal government would determine what quality health care is and financially reward the hiring organizations of physicians who will need to faithfully document their compliance with the new payment rules causing more administrative burden for doctors, not less.

Such promises are yet more ACA political whoppers! Recall President Obama’s pledge to the American public when selling the 2010 Patient Protection and Affordable Care Act (ACA): “If you want to keep your doctor, you can keep your doctor.” Well, how has that worked out?

Now four more lies: 1. “Doctors will be able to practice as they always have.” What is the evidence for this? 2. “When [doctors] get better health results [as measured by the government] and reduce the costs of care for their patients [as measured by the government], they receive a portion of the savings.” This creates a clear-cut conflict of interest and challenge to the physician’s Hippocratic oath to work for patients and do no harm. 3. “We’re giving doctors more freedom to practice the way they were trained, the way that makes more sense to them and is best for their patients.” Doctors are trained to act in their patient’s best interests, not their own. 4. “We’re helping to put people at the center of their care.” Quite the contrary, these rules would actually remove patients and families from this opportunity and responsibility.


Like many people, I rely on my doctor. I trust her to help me make some of the most important decisions in my life. I have come to her sick, worried and scared, and she has given me comfort, hope and a plan for protecting myself and my family.

America is home to world-class doctors. They train for years to understand the ins and outs of our health and the best way to care for each of us. But in today’s health care system, we often don’t pay for the best care they can give.

This video explains:

In the last few years, we’ve made tremendous progress to transform our nation’s health care system into one that works better for everyone. Key to this effort is changing how we pay doctors, so they can focus on the quality of care they give, and not the quantity of services they order. For years, people across the health care system have agreed that we need to improve the status quo. The Affordable Care Act created new tools to encourage innovation and help us improve how we deliver care. And now, the “Quality Payment Program,” the result of a bipartisan bill passed last year and supported by much of the medical community, strengthens these tools and gives us new ones.

Today, we announced the first step in this program, a proposed rule to guide its implementation. As the video explains, it does two things:

First, it replaces our patchwork collection of incentive and penalty programs with a single program where every doctor has the opportunity to be paid more for better care. Doctors will be able to practice as they always have, but will also have the chance to get paid more for high quality care and investments that support patients.

For doctors who want to go further, there is a second option that’s even more flexible. They can decide to be a part of new organizations that get paid primarily for keeping people healthy. For example, they could be part of an “accountable care organization” where doctors, hospitals, and other health care providers come together in one organization to coordinate high-quality care for the patients they serve. When they get better health results and reduce costs for the care of their patients, they receive a portion of the savings.

With these changes, we’re giving doctors more freedom to care for patients the way they were trained, the way that makes the most sense to them and is best for their patients. And we’re helping to put people in the center of their care.

Change isn’t easy, and this is just the first step in a complicated process. We know the transformation we’re working toward won’t happen overnight, and we know it might be challenging. That’s why we are working with experts in the medical field, doctors, nurses, hospitals, insurers and patients. We’re listening to our partners and working to make sure we get this right.

Efforts like this are important steps on our path to a health care system with better care, smarter spending, and healthier people. Through this work, we can build a health care system that works better for everyone.

—HHS Secretary Sylvia Burwell

MPPA Meeting Monday April 25, 2016 at 6 PM in Central Medical Building, St. Paul

Monday, April 25th, 2016

Those present: President Lee Beecher, Don Gehrig, Bob Geist, Mike Ainslie, Doug Smith, Wayne Zuehlke, Dave Racer, Lyle Swenson, Hannelore Brucker, Chris Foley, John English, Scott Jensen.

• March 8 Meeting—Doug Smith and Hannelore Brucker led a discussion of the meeting.
• Rick Morris’s message was read and seemed to sum up the effect of meeting well for the rest of us. Here is an edited copy of Rick’s message to Dr. Sue Bailey, Speaker of the AMA House of Delegates. From Rick: “Our group hasn’t changed its feelings about organized medicine seeming to abandon independents like you and me…what we feel is needed is an undiluted, full-on defense of the profession against the overbearing intrusions of the federal government (and other payers). We think that supporting MACRA [the “doc fix” law] just compounded the mistake of supporting PPACA. I can understand the political difficulties you have, but those of us in that room (and a lot of other “rooms”) are looking for staunch support for our ethical and professional lives, and the patients we serve. We find more compatibility with AAPS, for example…”
2. Report: Meeting places for the future discussion was led by Mike Anslie. Some Lund-Byerlys stores have community rooms which are very suitable. Turns out that our current meeting place may un-expectantly be available again when we want it—let’s see how things go in planning for our next (probable fall) meeting.
3. The focus of MPPA discussions was led by Scott Jensen.
• He wanted to know if there were 3 issues that we might think important for legislation. We suggested that the broad issue of empowering patients needed implementation and that Rep. Tom Price’s 2015 bill of the same name would be a good start for consideration. There are multiple items that might be pertinent here including the Family Medical Account (FMA) program, tax free put-of-pocket expenses, tax free individual policy premiums for equity with business federally qualified premiums, protect small clinics from EHR mandates, etc.
[Not mentioned, but something we’ve previously noted was what ought to be the goals of wise government economic policy. Joseph V. Kennedy (PhD—economics; M.S; J.D.), a noted economist, has written that, “Government policy is far more effective when it channels market forces than when it overrides them”. Individuals owning and controlling the resources that the government shares with them are likely to be prudent, while gaining equity in choice of medical care access and quality. “Ownership of resources is the path to a decent life free of poverty and dependency: a goal for all Americans.”]
• We also discussed how MPPA was started in 1997, and that now, as a think tank, we seek to examine the ideas that will permeate public opinion in order to bring about medical system freedom, safety, and justice for all families.
4. Future agenda presentations—Dave Racer suggested that we set aside a 20 minute briefings on topics pertinent to our discussion. The group approved a trial. At the next meeting Dave will present Reference Based Insurance plans.
5. Business contracting: professional vs. commercial and Direct Patient Contracting discussion was led by Dr. John English. We focused on his MIPA group’s Prima-Care Direct contracting method; a group of varying sized independent primary care practices.
• We had a preliminary background discussion regarding medical practice as being a professional business, which can be distinguished from a commercial Chevy dealer’s business down the street—they function under different laws and have different goals. For example, following passage of the U.S. HMO Act of 1973 there was an accelerating transition from a professional medical marketplace, in which services were sold to patients, to a commercial marketplace in which populations (or “covered lives”) of HMO insurance corporations and government agencies (the mega “payers”) were auctioned to providers for servicing (commonly at prices fixed by “payers”)—the essence of Managed Care 1.0. The Obamacare MC 2.0 cartel era follows in 2010.
• The Prima-Care Direct contracting program was outlined and critiqued at length. In general it was thought a good means to enhance access to patient-centered care: personalization, timeliness, continuity, and trust in care. It may not apply to older populations with more complex problems. Direct contracting through monthly payments as a form of cash practice was thought an idea that could flourish.
6. A pending problem was noted by Chris Foley. There are efforts underway to make filling a patient’s prescription in another state impossible without one having a medical license in that state. He will forward more information later.
7. We did not have time to get updates on: legislation; MN Medicaid federal investigation and MN responses to Hi-Lex v MI Blues case; “Value pay” and MMA “New Initiative on Reducing Health Care Costs”, MMA June 1 Harold Miller (of “evil FFS” fame) on MACRA and ACOs; or profiteering and bribes paper in the AAPS Journal Spring 2016.
8. We will be looking forward to reports on: MPPA website cleanup and support; website library; Briefing on AMA “Health 2047 an innovation Hub”; and further consideration of future 20 minute agenda presentations. For example:
• Feinwachs regarding Medicaid HMO profiteering.
• Robert Thompson, JD. MMIC presentation
• RWG. FMAs for Medicaid [old priority rank #5 (see page 5)]
• John Tyler HCTF presentation
• RWG. Political Malpractice and Profiteering at the bedside [old priority rank # 1]
• Dave Racer – Reference Based insurance plans—planned for next meeting.
9. There is a meeting of John English’s MIPA group on Wed, May 11 at the Embassy Suites Airport Hotel from 9 to 11:30 AM to which all are invited

10. Next meeting will be announced. Please think carefully about possible legislative initiatives for Scott Jensen and how we can help get elected!

Respectfully submitted, Robert W. Geist MD, Secretary pro-tem


1. Kennedy JV. Introduction ix, and Chap. 7 Affordable health care: In: Ending Poverty. Rowan & Littlefield Publishers Inc. Lanham, Maryland. 2008