Physician Patient

Archive for the ‘MPPA Publications & Pronoucements’ Category

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

Population-based versus Individual Healthcare: MN’s Expensive Big Data Collection Efforts Miss The Mark

Monday, May 25th, 2015

Minnesota health care providers are now required to report “quality measures” to the Minnesota Department of Health

Many Minnesota and US government policymakers are entranced by managed care practices justified by collecting and then drilling down on Big Data being which is now by law collected from Minnesota health care providers. Governments increasingly rely on vendor companies such as UnitedHealth’s Optum to do IT and data crunching.

So, MPPA is discussing government mandated health care “quality” data collection and evidence-based medicine. David Sackett, the putative “Father of Evidence Based Medicine” (who at age 80 recently passed away) steered medicine towards scientific evidence in justifying medical practices. He’d agree that it’s both unscientific and illegitimate to apply probability theory to Big Data sets in which the events (or things) studied are neither truly homogeneous nor repeatable a very large number of times.

How does this relate to true scientifically-based medicine? The answer requires a look at probability theory. Probability theory is a branch of mathematics frequently used in statistical analysis. Richard von Mises posed the following simple but revealing question in his great work Probability, Statistics, and Truth:

What does it actually mean to say that the probability of a die coming up as a two-spot is one-sixth?
What the probability fraction actually means is this: if the die is not loaded, and if it is thrown a very large number of times, it will tend asymptotically (See to come up as a two one-sixth of the time. The only way one can really make sure that the die is not loaded, i.e., that the two-spot will come up one-sixth of the time, is to make a large number of throws in order to do an asymptotic statistical analysis.

The rationale for requiring all Minnesota “health care providers” (physicians and other licensed professionals) to submit clinical information to the Minnesota Department of Health transactions is: Only by capturing large numbers of events or numbers (at great cost to society, providers and patients) can government, health plans, employers, and consumers (patients and families) tell which “providers” are doing “quality” practice. And, therefore, which health care procedures, hospital confinements, and medications will be eligible to receive third party dollars.

It is false to say that the “probability of Hillary Clinton (even after the Democratic Party nomination) will be elected President in 2016 is (name the number — 1/2, 1/4, 1/20.. or whatever) because US Presidential elections are not homogeneous events and are not are repeated often enough to do a asymptotic analysis. Likewise, It is false to proclaim that all patients should receive drug X or treatment Y because of the probability of success (good outcome) as deduced from Big Data (even if the IBM Watson computer or United HealthCare Optum does it).

Here is the point: A good deal of “mathematicalizing” [a new word] in social science and health care policy inappropriately applies probability theory to studying individual medical care treatment options, decisions, and patient choices. This is truly false science. And Minnesota policymakers need to become very skeptical of reliance on health care clinical care “quality” collection.

Instead, scientific studies comparing the costs and outcomes of Direct Pay (cash) practices vs. managed care clinics which use provider pay-for performance formulas based on population-based clinical care “quality” data must match a sample of doctors and patients who are free to make make medical care decisions with a similar sample from government-directed managed care. Such studies are not possible using the “quality” data currently being collected by the Minnesota Department of Health. De-centralizing medical care decision-making should be encouraged by Minnesota policymakers and insurance companies. Hopefully state and federal policy will empower consumers (patients and families) financially and encourage them to find and engage doctors and other health care professionals of their choice. This is where Minnesota and the Nation need to go.