Doctors Unchained

Alieta Eck, MD  4/29/2013

 

On April 26, 2013, The American Board of Medical Specialties (ABMS) was delivered a shot across the bow. Physicians who had been laboring under increasing burdens and requirements have finally said “enough is enough.” The Association of American Physicians and Surgeons (AAPS) served this Board with a lawsuit in the federal court in Trenton, NJ.

The ABMS is the umbrella organization that accepts dues from 24 specialty medical boards. They have developed an ongoing program of Maintenance of Certification (MOC) and are asking states to use this same testing for Maintenance of Licensure (MOL).

Medical insurance plans and hospitals are increasingly expecting all of their physicians to enroll in the MOC programs. What was once considered a mark of excellence, board certification, has turned into a mark of competence, something that has never been proven.

The charge is that the ABMS and its 24 Boards violate antitrust law and misrepresent the medical skills of physicians who decline to purchase and spend time on its program. The Boards invite patients to go online to see if their physicians are enrolled in MOC, as if they can prove that this has any bearing on their clinical skills or ability to care for their patients. These Boards regulate themselves with no outside oversight. Physicians cannot see where they made mistakes on the test and have no way to appeal or to verify the accuracy of the grading. The tests are pass-fail, and designed to have a certain failure rate, ;which could be 20 percent or more, depending on the Board. Many a physician has lost his ability to practice medicine in his current location because of MOC—even though he has been doing an excellent job for his patients.

The new Chair of the American Board of Internal Medicine (ABIM), Dr. Bob Wachter, claims that the overall picture of American healthcare “is not pretty: there are too many mistakes, quality is often shoddy, variations are the norm, access is spotty, seamless coordination is rare, patient-centeredness is unusual, and costs are unsustainable.”

He goes on to proudly describe MOC on the ABIM website as “more than passing a test every ten years. It now includes measuring one’s own practice patterns and submitting plans for improvement, reviewing patient and peer satisfaction surveys, and more.” Dr. Wachter realizes that this will not make doctors happy, but believes it will “bolster the credibility of board certification, and thus of professional self-regulation.”

So there. MOC is a way to bolster the image of the Boards. It is also a way to bolster the income of those who serve on these Boards, as some have compensation packages nearing $1 million. The idea that this is a way to improve the clinical skills and knowledge of doctors is unfounded, for doctors know otherwise. The best way we continue to learn is by reading, consulting with our colleagues, and actually caring for our patients. Each patient we see is a test of our skills.

No other profession is as over-regulated and, frankly, exploited as the medical profession. The cost to enroll in MOC and to take the courses needed to answer questions often far removed from the niche specialty the physician has chosen, and the time away from caring for patients, all take a toll on the physician. Many will time their retirements on that deadline of taking the next proctored, all-day exam, far from home.

Doctors need to be freed from the overbearing regulators and those who would bind us up with mandates, red tape, form-filling, and testing. Patients need us, and we want to be there for them. Unshackle us!

Medicaid is a Poor Substitute for Charity

By Alieta Eck, M.D.:

What is the best way to care for those who are sick and have no funds to pay? Can the government really handle the problem?

For the past 9 years, my husband and I have run a non-government free clinic, the Zarephath Health Center. It has taught us many things about the poor. We have learned that the causes of poverty are as plentiful as the numbers of patients we see. Some are victims of circumstances, poor parenting, or the vices of others. Others have no one to blame but themselves. But they all need encouragement and a kind word.

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Medicaid Is Mismanaged Tax Dollars

By: Alieta Eck, MD,

The essence of Government is power; and power, lodged as it must be in human hands, will ever be liable to abuse.” James Madison.

When government controls health care, bureaucrats war against bureaucrats, medical care becomes a commodity, and the taxpayers pay dearly.

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Medicare, the AMA and Creeping Socialism

 
Dr. Robert Sewell presents a concise history of Medicare in America that can be accessed by going to  http://www.spiritofhealthcare.com/?p=217  Here is the response by Dr. Ralph Kristeller:

Bob--Your excellent email on Creeping Socialism deserves more time than I am able to muster.

 “Casey would waltz with the strawberry blonde and the band played on.”

Substitute the term AMA for Casey and the word politicians for strawberry blonde and that describes the reason for the current health care mess.

Words do count: “Medicare Fee Schedule” should have been stricken from the vocabulary. It is a Payment Schedule and the AMA should have jumped on it right from the start,  just as they should have jumped on the outrageous phrase “health care is a right”. The AMA “never misses an opportunity to miss an opportunity”

I am incensed over my personal experience whereby one of my physicians has opted out of Medicare. I continue to pay Medicare taxes yet in the case of his opt out I can not submit a claim or receive any payment from Medicare. In short it’s premium collection with no “benefits.” It amounts to taxation without representation. It goes with the thoughts in your fifth paragraph.       

In brief the AMA is expending all its effort to change the payment for physicians in a system that closely resembles the Code of Hammurabi. They should be expending all their effort to re-establish a system that closely resembles the oath of Hippocrates. The oathis based on autonomy for physicians. Autonomy includes the right to freely contract.

The code of Hammurabi excludes autonomy and so the politicians cleverly frame the debate and the profession stupidly falls for the ruse.

 With regard to your email, as the saying goes: “Good job”

 As always warm regards

 Ralph

EMRs Not Streamlining the Practice of Medicine

by Craig Wax, DO

Lately the voices to buy, implement, and use EHRs (electronic health records) are deafening. Eligible professionals who implement a certified EHR system and demonstrate meaningful use can receive up to $44,000 over 5 years under the Medicare EHR Incentive Program. To be eligible for the maximum incentive payment, Medicare-eligible professionals must begin participation by 2012—which is not very far off in the future.

Even physician licensure boards are now recommending the implementation of EHRs. According to a recent article, "The Federation of State Medical Boards (FSMB) says it recognizes that electronic health records could be used by doctors both to improve patient outcomes and assess ongoing clinical competence for purposes of medical licensure." (HealthcareITnews.com, September 14, 2010)

Promises and rumors about EHRs abound. EHRs make you more efficient and, at the end of the day, more profitable. EHRs are stable and can be accessed anywhere via the Internet. EHRs reduce or eliminate errors, therefore reducing your malpractice liability. Quite frankly, I believe that these claims are without merit and supporting data—in fact, at the present time, I would call them "bunk."

A CLOSER LOOK 

When you look more closely, many of these deafening voices have a financial interest in EHRs. Some of the voices are EHR salespeople or even physician EHR consultants who make money off the deal and aren't objective in their views.

Government leaders decided earlier this decade that they were going to target physicians with EHRs. Why? The reason is that the insurance industry and government can't access our data while it is on good old reliable standard paper. I believe that they want this data so that they can change the system by which we are paid, or in other words, find a new way to deny pay for physicians and therefore reduce "health expenditures."

Standard indemnity insurance, PPOs, and even HMOs didn't reduce the costs of care. In the end, to the insurance companies and to the government, it is all about costs. Don't let them fool you with the latest, emperor-has-no-clothes "pay for performance" quality care rewards that are currently being promised. I don't believe this will improve care or provide a return on investment for your medical education, training, and experience.

My office has been set up as what I would consider to be a "patient-centered medical home" since I started the practice in 2001. We see all ages for just about all issues, including primary and secondary prevention. We write prescriptions, perform tests, do procedures, and coordinate referrals. Half of the work has become focused on insurance and billing issues, though.

We have to determine patients' insurance eligibility before they even set foot in the office. Then we have to determine their copay and other specific insurance requirements. If we order a cardiac stress test or MRI, we must spend time and effort pre-authorizing the procedure through their insurance system. We even have to prior authorize most branded medications through a similar process for every new prescription or when patients change insurance or their insurance changes policies at will. This can be yearly or even more frequently.

Then comes the billing piece. We have an outsourced billing service that we pay a percentage to just so that we can enter data and send electronic bills through a clearinghouse to the insurance company so that we may be paid within 1 month. Then comes the fun of reconciling the bills and payments and fighting for what we were inappropriately denied for care already rendered. For instance, our local Blue Cross Blue Shield denied my hospital admission for a 40-year-old woman with chest pain, shortness of breath, and documented pulmonary embolism!

Insurance and government "compliance" are eating up half of the time clock for patient care. When is a physician supposed to make time for actual patient care, let alone continuing medical education and process improvement?

Government Job Creation Is Not Always a Good Thing

By Alieta Eck, M.D.

When economist Milton Friedman observed mine workers in China digging a canal using shovels, he asked why they were not using modern machinery. He was told that this was a “jobs program” and that using shovels employed more workers. Friedman then quipped that they should give the workers spoons, not shovels. China had lost sight of the fact that the purpose of the work was to build a canal to increase commerce and enhance the lives of the citizens. Using machinery would lower the cost of the project and benefit the taxpayers.

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Addicted to Government

By: Alieta Eck, MD,

It begins with an injury-- a torn shoulder, a crushing back mishap, an abdominal operation. The miracle medications relieve the pain very well. However pain has an emotional component, and in some patients the need for narcotics far exceeds the time frame of any typical physical condition.

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Many U.S. employers to drop health benefits: McKinsey

(Reuters) - At least 30 percent of employers are likely to stop offering health insurance once provisions of the U.S. health care reform law kick in in 2014, according to a study by consultant McKinsey. "The shift away from employer-provided health insurance will be vastly greater than expected and will make sense for many companies and lower-income workers alike," according to the study, published in McKinsey Quarterly.

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The [Insurance] Empire Strikes Back

By: Alieta Eck, MD

When my husband and I spent two years in Mexico, we became very thankful for our own country where we were protected from "organized thuggery." At regular intervals we would have a visit from a uniformed police officer, letting us know that we needed to pay something like $10 to be sure that our house would not be robbed. Of course that seemed strange, as the job of protecting the neighborhood ought to be a normal function of the police.

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Physicians Say Government "Charity" is a Cash Cow for Special Interests

By Alieta Eck, MD

Physicians are waking up to the fact that they have been used by self-serving politicians and insurers. Their licenses have been co-opted by those who have profited greatly. While physicians were busy studying hard, excelling on their exams and putting in endless hours of often thankless care in their residency training, the MBAs were dreaming up ways to siphon off the fruits of their labor.

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Medicaid Hurts The Poor, The Physicians and The Taxpayers

By: Alieta Eck, M.D.,

In 1821, Josiah Quincy, a legislator in Massachusetts noted that the poor are of two classes. 1) Those who are wholly incapable of work-- through old age, infancy, and sickness and 2) the able poor-- those who are capable of work. At first he believed that the government was a perfectly reasonable deliverer of help to the first category, but soon learned that there was no good formula to determine who belonged in which group.

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ObamaCare Endgame: Medicaid for All

By Richard Amerling, M.D.

Too many physicians endorse the “single payer” concept. Some are legitimately frustrated by the increasing difficulty in getting paid by private insurance companies and so called “health maintenance organizations.” My response is, “What if the single payer is Medicaid?”

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Medicaid Realities: More Harm than Good

By: Tamzin A. Rosenwasser, M.D.,

On January 7, 2011, 33 governors and governors-elect sent a letter to the White House and Congressional leaders detailing how new federal Medicaid mandates will drown their states in more debt.

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Insights from a Medical Malpractice Carrier Executive

By Peter Leone

I have spent 34 years primarily handling an estimated 40,000 malpractice claims. In addition, I have attended several hundred trials and made the ultimate decision on hundreds more. I have personally settled several hundred claims in excess of $500,000.

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ObamaCare: Physicians’ Perspectives

By David Hogberg, from Investor's Business Daily

As this week’s first anniversary of ObamaCare comes to a close, it is a good time to look at the perspectives of the people who will be at the center as the new health care law unfolds, physicians.

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