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

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 government’s 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 America’s 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 won’t 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 government–mandated 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.

Socialized medicine began with Willard Romney ... who also imposed gay marriage.

YOU ARE THERE

THE IMPOSITION OF OBAMACARE/ROMNEYCARE
AND DEATH PANELS BY MYTH ROMNEY,
THE “SWIMMER” AND THEIR TRAINED (INCARCERTED, TESTIFYING) FELON.

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?

Corporate lawyers and bean counters working for the healthcare insurers that's who. The ones who whiz on themselves in delight when one insignificant error is fould so they can make the doctor refile.

Insurers own a majority of Congress. They have the largest lobby. What they want all the way down to the size of your cold drinks sold in stores they get laws passed for it.

Over 75% of the laws, codes, ordinances,etc on the books today are there because insurers pushed for them from the federal level on down.

Lyndon Johnson drove the first nail in the coffin of health care. Ted Kennedy said no nails just won't do it we also need to use screws and glue. Obama said the health care system is still breathing and costing insurers. He ordered to open the box and drive a steak through the heart of healthcare and seal it all back up and bury it in a sealed vault.

I wish there were some kind of resource that one could contact to find doctors like this, who are operating this way.

I know of one doc in my area who gave up accepting insurance years ago - even then he was disgusted with all the interference with his care of patients.

-JT

Two years ago we used to do practice management, including all accounting, payroll, tax prep, pre-auth and billing, for docs who serve patients in fields of surgery, pediatrics, orthopod, anesthesiology, lab and mental health. We stopped providing any kind of pre-auth and billing services for everyone except mental health providers in January 2015.

Many of those docs I chose to drop billing and pre-auth services for have since quit taking any insurance at all because they simply could not afford the personnel, constant training and software resources it was going to take just to handle the paperwork of a solo practitioner.

Have been in this line of business since 1985 and been through more changes that I even want to remember. This is just going to be the granddaddy of all messes, particularly for Medicare providers who will be the first group under the gun.

I’m a little confused because just about every medical practice operating in the US today uses some kind of third-party software application to do all of the insurance claims work, and that software would have been updated to do ICD-10 without the practitioner having to do any actual conversion. I suppose that the office personnel would have to learn new codes, but I would think that would also be a click down menu with shortcuts for procedures the office does on a regular basis.

That said, I certainly support this physician in his views on the state of health care and insurance. My own physician stopped taking Medicare patients a couple of years ago due to the same type of concerns.

Best of luck with the practice going forward.

much of the practice software in current use were not built to accept the 6 digit ICD-10 codes.Upgrades are expensive.
Also, even though office staff enters the codes in the software, the physician must supply them with the correct code, or the staff must wade through the dictations and many more possible codes.

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YOU ARE THERE

THE IMPOSITION OF OBAMACARE/ROMNEYCARE AND DEATH PANELS BY MYTH ROMNEY,THE “SWIMMER” AND THEIR TRAINED (INCARCERTED, TESTIFYING) FELON.

THE IMPOSITION OF OBAMACARE/ROMNEYCARE
AND DEATH PANELS BY MYTH ROMNEY,
THE “SWIMMER” AND THEIR TRAINED (INCARCERTED, TESTIFYING) FELON.