Dr. Kris Held is an ophthalmologist in Texas. She is someone who puts a higher value on the doctor:patient relationship as defined by Hippocrates than she does working in a bureaucratic system where doctors and patients must get permission from a third party to agree on a treatment plan. Ever since I started following her even before I joined the Association of American Physicians and Surgeons, I have been impressed with her intelligence, courage, and tenacity. It was brave doctors like her, Dr. Jane Orient, Dr. Keith Smith (at Surgery Center of Oklahoma), and Dr. Lee Hieb who inspired me to declare my independence from a corrupt system.
While most doctors grumble about the de-evolution of medicine, most, out of either fear, ignorance, or apathy, do nothing about it. They simply put their nose to the grindstone and hope that the people to whom they have ceded the power to decide how healthcare should be delivered will someday change their ways and show mercy. It reminds me of the oft quoted definition of insanity…
In response to the madness, some physicians retire early, some change careers, some become cynical burnouts, and some go over “to the dark side” and join the ranks of the administrators/collaborators and become part of the problem, not the solution. A few decide to take a stand. At some point, their line in the sand has been crossed and they know that they must make a fateful decision and cross their own Rubicon.
I crossed that river over two years ago and burned the bridges behind me by opting out of all third party reimbursement when I realized that Obamacare would impose rationing of care through several methods, especially so called Accountable Care Organizations (ACOs). For many doctors, like Dr. Held, implementation of the ludicrous ICD-10 coding system for billing, became the last straw.
I applaud Dr. Held. I hope that she keeps writing. She is far more articulate than I in defending the doctor:patient relationship among other things near and dear to my heart. I have no doubt she is inspiring doctors and patients across the country.
Below is the letter she sent to her patients about her reasons for no longer accepting payments from commercial insurance companies. I think you will be impressed. (Click here to visit the original posting on her blog.)
Michael A. Ciampi
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. 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.
Kristin S. Held, MD