Skip to comments.Letter my remaining private insurance patients will receive
Posted on 09/18/2015 5:02:31 PM PDT by dontreadthis
FULL TITLE: Letter my remaining private insurance patients will receive as I am forced to forced terminate all 3rd party agreements as of October 1- the day HHS mandates ICD-10 implementation
September 13, 2015
Dear Cherished Patient,
I most humbly request you take a few minutes to read my heartfelt letter to you. Whether I have cared for you for the past 20 years or you are new to the practice, I want you to understand that I value our relationship most highly and regard my service to you as your physician and surgeon as a privilege and a blessing. I honor the Hippocratic Oath and will treat you individually to the very best of my ability with dignity and privacy.
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 XVIII SEC.1801. In 2010, President Obama signed the Affordable Care Act with the promise, If you like your doctor, you can keep your doctor. Period.
Tragically, over the past 50 years, the governments pledge to not interfere with the practice of medicine has been broken. The law has been unheeded and continuously altered, such that the practice of medicine in the United States has been fundamentally transformed, commandeered, and all but lost. Your right to keep your doctor has been lost as well. My right to freely practice medicine has been lost as well.
October 1, 2015, the Department of Health and Human Services of the Executive Branch of the United States federal government requires that in order to bill for services physicians must implement ICD-10, the 10th revision of the International Classification of Diseases and Related Health Problems, a medical cataloging system of the World Health Organization that includes 141,000 diagnosis and procedure codes including W56.22 Struck by Orca, initial encounter, V91.07 Burn due to water-skis on fire, V97.33 Sucked into jet engine, X52 Prolonged stay in weightless environment, V95.40 Unspecified Spacecraft accident injuring occupant, and even VO6.00xA for when Grandma gets run over by a reindeer. The costs of ICD-10 implementation are staggering, far outweigh any perceived benefit, and are a vital factor separating financial sustainability from bankruptcy for private medical practices going forward. ICD-10 implementation was fought vehemently and delayed 2 years, but ultimately, money from lobbyists representing hospitals, IT (American Health Information Management Association), and other special interests bought votes and trumped the best interests of Americas patients and physicians. ICD-10 is required for all health care providers, billing agencies, clearinghouses, and payors that transmit patient data electronically (all HIPAA covered entities), not just Medicare and Medicaid.
Government is now virtually extorting physicians in unprecedented fashion. If physicians do not precisely follow government rubrics and implement and comply with everything the Secretary of Health and Human Services says, we are penalized. I am not implementing ICD-10, because it is nonsensical and doing so does not serve my patients first and is not the best utilization of resources. If I implement this nonsensical, wasteful system, what wont I do? This is my line in the sand. Therefore, as of October 1st, I will be unable to submit claims for my services to you to your insurance company, because they will be rejected. I will be forced to terminate my agreement as an in network provider with your insurance company.
Just as government has broken its pledge not to interfere with the practice of medicine, it has broken its promise to you, the patient. On April 16,2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and soon government will be implementing Alternate Payment Models and Merit-Based Incentive Plans for physicians that are perversely incentivized, such that doctors who follow marching orders from the Secretary of HHS (a non-doctor appointed bureaucrat) will be rewarded monetarily and with a high, publically posted Composite Performance Score; those who do not do her bidding so well will be penalized. Further, if less money is spent on patients, more money is retained to profit the entities that ultimately pay, and thus control, physicians. Initially this will apply to Medicare patients but will be expanded to include all third party insurers. Think about it- we now have a system whereby you are forced to buy what amounts to prepaid healthcare from an insurance company that profits by restricting and denying the very care they are paid to provide. You have to pay them. They keep more money when they provide you less care.
Government has betrayed us, but we must not betray one another. The preeminent, inviolable relationship that must be preserved exists between patient and doctor. The insurance company-customer and government-subject relationships are secondary by great orders of magnitude. I am asking you to continue in my care. I will provide you with a transparent fee schedule that is fair, reasonable, and in many cases less than Medicare. My services may cost less than those of your hairdresser, mechanic, or any other professional with whom you do business.
Of utmost importance is your understanding of the convoluted healthcare system in which we are forced to live. Education and communication are critical for us going forward. Our premiums, deductibles, and copays have sky-rocketed. Our access to and networks of hospitals, doctors, and medications have been severely restricted. You will be pleasantly surprised, and in the long run you will be better served by staying in my care- outside of the restrictions and wastefulness of your insurance plan. For example, if your copay is $70.00, it costs you only $15 more to stay with me for your follow up exams. If your deductible is $5000.00, and your insurance company has negotiated allowables with surgery centers for cataract surgery or other operations, you will find my fees to be lower and you will save money to the tune of thousands of dollars. You will spend more using your insurance in many cases. Most importantly, you will not be subjected to what I call the insurance shuffle where each year you will have to start from scratch with a new in network insurance doctor du jour who knows nothing about you or your medical history and will spend but a few impersonal, data-collection-focused minutes with you. If you stay in my care, you can remain confident and comfortable in an ongoing, lifelong patient-physician relationship of mutual trust and respect. There is unquantifiable value in the patient-physician relationship that is focused on what is best for the individual patient as opposed to dealing with a third party controlled doctor who must enter meaningless data into government mandated electronic medical records that will be shared with authorized users who will have full access to patients private medical records. Guess who will have acces to your confidential records- a provider of services, a supplier, an employer, a health insurance issuer, a medical society or hospital association, or any entity that is approved by the Secretary of Health and Human Services as determined by the Secretary. I will put you and your well-being first, in place of nonsensical, if not harmful, government rubrics that serve the collective good and political ruling class at your expense. I will keep your personal medical information confidential and share it with no one without your consent. I will not violate my pledge to you. Please, stand with me.
If you chose to stay with me, you can personally file a claim with your insurance company for my services as an out of network provider. You, an individual patient, are not mandated to use ICD-10 codes. You are paying the insurance company; the company must deliver what it promised to provide. If you like your doctor, you apparently must now fight to keep you doctor. I pray you will. If you leave, I pray you will come back.
My choice is to violate my code of ethics and implement governmentmandated ICD-10 and all other subsequent diktat or to terminate agreements with insurance companies and serve my patients first. I cannot continue to enable this perverse, wasteful, dysfunctional system. I pray you will work with me in a new paradigm-shifting, alternate universe where you have an actual doctor and actual medical care in lieu of government-mandated insurance that comes with neither. Enclosed you will find my fees. My staff and I are available to answer your questions and address your concerns. I appreciate your time and consideration of this critical matter.
Kristin S. Held, MD
Glad to see this. I’d like to see Americans of all stripes “opt out” of the government’s many bureaucratic networks. Maybe we could go back to a barter economy and live off the land until the madness around us implodes or gets butchered by ISIS.
Yeah, lots of my doctor friends retiring.
It’s not good out there, I get this doctor’s pain.
“—— government mandated electronic medical records that will be shared with authorized users who will have full access to patients private medical records.”
Such as Healthport of Alpharetta,GA where my Massachusetts medical records were sent,much to my dismay.
Someone is getting very rich.
Our General Practice Dr. has told his kids not to become Doctors.
ICD-10 and DSM-V are both nothing but extreme left-wing liberal nonsense.
This began with Romney and the GOP.
They should be thanked, as should the GOP
which has kept THEMSELVES EXEMPT from ObamaCARE, too.
The GOP is a curse on America, even before it
began to impose polygamy and marriage to animals.
And yet I am amazed at the change over the past few years -- premiums through the roof, deductibles are outrageous, and every medical procedure that is performed now comes with a big bill that I have to pay out of pocket. And scheduling appointments is harder, and the paperwork I receive is almost impossible to understand.
It's just a horrible state of affairs. Finest health care system in the world -- pretty much destroyed in about 5 years. Amazing.
My mom had been a registered nurse for 20 years in 1965. The doctors she worked with then saw through this BS, accurately foretelling the world today's doctor described in this letter to patients. The gutless wonders we have for Senators and Representatives refuse to see what is right in front of them. The slippery slope is real.
I have nothing but contempt for insurance companies and their corrupt government co-conspirator associates.
Pretty much destroyed, like what government did to our borders, sovereignty, immigration policies, our economy/epic debt, our military, our schools/education and on and on.
One way or another, these people need to be held responsible.
The doctor is bailing out of newly created insurance/government controlled medical industry. Sounds like he will take cash or whatever works for him. Thousands of other doctors have and will bail out of the corrupt system all together.
Mandatory use of ICD-10 does become effective on 10/1/2015. Was supposed to happen two years ago but kept getting postponed because the government wasn’t ready. All my doctor clients who are mental health car providers use DSM-IV which was basically the same as ICD-9. Worked fine for them.
ICD-10 is going to be an absolute nightmare, particularly for any kind of a provider for medical services. Several clients have already resigned from all networks but some of their provider contracts require as much as a six month notice so it’s going to be next spring before they are officially out. In the meantime, we have stocked up on several large bottles of wine to carry us all over for a bit.
just had some minor surgery and have been amazed at how well I have been able to negotiate costs with my surgeon, anesthetist and the hospital.
I think they welcome a quick lower cash payment without having to go through the insurance payment BS.
I’m actually building good relationships with these people and have come out ahead of the game.
I’m thinking you will start seeing a lot more of this. Where there is resistance in the marketplace, new avenues are created.
This is some of what MDs are up against. AND you better get the billing right or your can be/are fined big time.
(move the cursor over the icon just to the left of the flag and right of “2015 ICD-10-CM Diagnosis Code W22.02”
I’m paying $400/mo for a policy with a $10k deductible. I haven’t even bothered to select a new primary care physician after getting bounced off my policy (twice) due to Obamacare implementation. I’d love to meet this doctor!
Who in Hell (well really there is one in hell who is a major suspect) had the time and assignment to make this stuff up?
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