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Heartland Institute – Give Each Medicaid Patient an HSA with $7K

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Heartland.org just published an editorial in the Wall Street Journal that upends the regulatory model of Medicaid by streamlining the benefits and getting “the swamp” of Washington, D.C. out of the way.

By Justin Haskins & Michael Hamilton

The GOP’s recently benched health-care bill would have substantially reformed Medicaid by giving the states block grants, along with more flexibility on how to spend the money. But there’s a better model. Republicans should empower Medicaid patients by providing funds to them directly, which would allow them to build a personal safety net that could last a lifetime. A $7,000 health savings account per year would save the government billions of wasted dollars while expanding personal choice.

Read the full paper here

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Blockchain Causing a Stir

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Crypto-currency the future of EHR?

Doctor’s Lounge host Michael Koriwchak spent the hour of his latest show examining the trends in Health IT and the backbone of Bitcoin came up.

Bitcoin, the digital currency, rose to prominence from its start in 2009 built upon Blockchain encryption and records keeping technology.

Instead of a database that is centrally located and maintains the records (be they currency or health records), blockchain shares the data among a network of computers allowing users to add transactions (or information blocks) to the chain.

The information is kept secure through cryptography and distribution over a wide array of computers.  The implications of a decentralized network maintaining records and overcoming the ongoing challenges of interoperability have excited a flurry of articles and papers over the past six months.

This is precisely the type of innovation that explodes when the regulatory burden in removed and entrepreneurs are free to experiment and solve problems organically rather than by bureaucracy.

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Blockchain to Transform EHR?


Crypto-currency tech moving to Health IT

Michael Koriwchak, M.D.Bitcoin, the digital currency, rose to prominence from it’s start in 2009 built upon Blockchain encryption and records keeping technology.

Instead of a database that is centrally located and maintains the records (be they currency or health records), blockchain shares the data among a network of computers allowing users to add transactions (or information blocks) to the chain.

The information is kept secure through cryptography and distribution over a wide array of computers.  The implications of a decentralized network maintaining records and overcoming the ongoing challenges of interoperability have excited a flurry of articles and papers over the past six months.

Host Michael Koriwchak, M.D., our in house Health IT guru will unpack the complexities and comment on the problems and possibilities ahead.

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Meeting with HHS Secretary Price

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Key Principles in Shaping Health Care Policy the Focus

Years of sharing the vision for the sanctity of the doctor/patient relationship are paying off.

Health and Human Services Secretary Tom Price, a doctor himself, invited Hal Scherz, M.D. of the Docs 4 Patient Care Foundation to a meeting to discuss the state of health care and important reforms to prioritize over the coming months.

Secretary Price, then a Congressman from Georgia, was instrumental in the creation of our original incarnation as a 501(c)6 organization and remained a steadfast personal and public friend throughout his tenure in Congress.

Scherz and PriceThe meeting entailed many topics but focused on the regulatory burden on doctors and the necessity of freeing physicians to spend more time with patients.  These fiscal and regulatory burdens have driven far too many out of private practice altogether or into the arms of large medical systems.

Scherz explained the need for the protection of Direct Primary Care at the federal level to protect doctors from aggressive state insurance commissioners who seek to regulate the doctor/patient relationship as if the doctor is an insurance provider.

Additionally, Scherz emphasized the need to explicitly allow the use of HSA dollars in DPC relationships.  A simple practical change that would go far to extending actual care to patients at the ground level where most health issues can be resolved if addressed early.

After the meeting, Dr. Scherz released the following,

“The Docs 4 Patient Care Foundation is delighted to have the kind of leader at HHS who has been on the front lines of American medicine actually delivering care to patients combined with the practical legislative experience of a successful tenure in Congress. Most importantly, Secretary Price fully understands the underlying principles behind the sanctity and primacy of the doctor – patient relationship in health care.

We know of no one better equipped by professional experience and personal philosophy to be directing perhaps the largest and most influential entity in health care in America, the Department of Health and Human Services.”

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Prostate Standards Revised

Scherz reviews the new standards and tackles the latest health news

Hal Scherz, M.D.Host Hal Scherz, M.D. returns to the Doctor’s Lounge to discuss the new standards rolling out in the American Joint Committee on Cancer (AJCC) Staging Manual.

Recommendations for prostate testing as well as mammograms have been swinging back and forth with perhaps the largest fury erupting over the USPSTF recommendations prioritizing economics and population data over the doctor’s clinical judgment.

Scherz, a pediatric urologist, will comment on this and the health news of the day.

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There’s a growing movement of surgery centers and specialists that list their prices and don’t take insurance

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When Cheryl Millican found out she needed surgery, her Dallas-based doctor told her it would cost roughly $38,000 out of pocket.

Millican, who doesn’t have insurance, needed a hysterectomy, a procedure that removes all or part of the uterus. It wasn’t an emergency situation, so when a friend told her about a place in Oklahoma that could perform the surgery for $8,000, she decided to look into it. That included the cost of the procedure itself, an overnight stay, a follow-up appointment, and any other meetings ahead of time.

In August 2016, Millican drove the three hours to the Surgery Center of Oklahoma in Oklahoma City to get the procedure for $30,000 less than she might have paid.

In March, Business Insider reported on a new movement happening with primary care doctors. It’s called direct primary care, and it works like this: Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices.

It’s happening at a time when high-deductible health plans are on the rise — a survey in September found that 51% of workers had a plan that required them to pay up to $1,000 out of pocket for healthcare until insurance picks up most of the rest.

Read the full article at Business Insider.

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Maintenance of Certification

Freedom Caucus Vindicated as Republican Leadership Pledges Repeal & Replace

Med Edison, M.D.Dr. Meg Edison touched off a firestorm in late 2015 when she decided she had had enough of MOC.

Edison exposed MOC (maintenance of certification) for ABP (American Board of Pediatrics) as a large scale money making scheme that allowed its leaders a laundry list of luxuries while costing struggling pediatricians thousands in direct fees, testing, and office based self reporting.

Edison published her reasons and ignited a groundswell of support from like minded doctors.  The ensuing outrage has even risen to a general vote by the AMA to (in part) reject MOC requirements for practicing physicians.

Meg steps into the Doctor’s Lounge with host Michael Koriwchak, M.D. to update us on the battle over MOC taking place in states around the country.

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AHCA Post-Mortem

Freedom Caucus Vindicated as Republican Leadership Pledges Repeal & Replace

Michael HamiltonMichael Hamilton, Managing Editor of Health Care News for the Heartland Institute, just published “Health Care Reform Lives, Vindicating House Conservatives” and steps into the Doctor’s Lounge to discuss what happened, what went wrong, and how the potential for real reform (that was actually passed in prior Congressional) sessions is stronger than ever.

Host Michael Koriwchak, M.D. plans to discuss the opportunities ahead as Republican leaders reset for the future and commit to getting health care reform done.

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The GOP Fumble of Health Care Reform – Post Game Analysis

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If Washington politics was the NFL, then the GOP was the Atlanta Falcons in the Super Bowl, snatching defeat out of the jaws of victory. Everything was set up for a clear win – majorities in Congress and a President who was itching to affix his signature to a bill that would send Obamacare to the scrap heap of history. But they fumbled the ball on the one yard line, and now the GOP is licking their wounds and everyone wants to know what the heck happened?

Most GOP supporters around the country are angry and confused because they expected more from this Congress. Others are furious that this bill did not sufficiently differ from Obamacare and are relieved that it failed. The Democrat supporters were against anything that attempted to undermine their beloved Obamacare, blind to the fact that it is imploding and soon will be no more, and ignorant regarding the ramifications.

It might be useful in the post-game analysis to try to explain some things and offer some perspective.

This entire affair can be better understood if certain concepts are introduced into the discussion- politics, strategy, and messaging.They often all run together, as was the case here.

Politics is the art of the possible, not the perfect. In the case of the GOP as opposed to the Democrats, politics is not a team sport, as much as we all wish that it was. There are too many people who want credit, and too many who will take their ball home if they don’t get their way.

One criticism of this bill was that it was crafted by leadership without input from other factions in the Republican House, like the Freedom Caucus or the more moderate Tuesday Group. Maybe that was a strategic error. Ultimately, these groups didn’t get what they wanted, so they sunk the bill.

Messaging has always been a problem for the GOP, and once again they did not disappoint. We heard repeatedly that this was a three-step process, but not enough time was spent explaining the ultimate vision of where we were heading with this process. America wanted specifics, not promises, so it is no wonder most everyone is confused. Only those of us who can identify the photos of all the Cabinet members understood what reconciliation meant and that Speaker Ryan was designing a bill that could be introduced into the Senate via this process.

It is easy being an armchair Monday morning quarterback, but perhaps there is a way to tie politics, strategy and messaging all together. What if the House created a bill that contained ALL of the elements of what we wanted to see in a repeal and replace package? What if they clarified to the American people exactly what the GOP vision of a health care plan would look like? This would be done knowing that the Senate would filibuster this bill and never let it come to the floor for a vote. But it would have put the Democrats on the defensive and it would have telegraphed to the American people what healthcare would look like after Part Three. It would have smoothed out the process of then following up with a reconciliation bill, making it easier to get that Part One passed.

There were more good things in the American Health Care Act than there were bad. It was the first time in history that an entitlement was being eliminated, and in this case it was two: Obamacare and the federal control of Medicaid, by giving it back to the states. Medicaid spending was being capped. The limit on HSA contributions nearly doubled. Tax equalization for individuals who purchase their own healthcare was established. And money was being allocated to states to re-establish high risk pools that were eliminated under Obamacare.

The GOP will get another chance to tackle healthcare reform, because Obamacare is failing and Americans are being hurt by it. They must stop being the opposition party and begin to govern. Let’s hope that the next shot that the GOP has at this is a controlled drive to the goal line and not another Hail Mary pass.

This originally appeared on Townhall.com.

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Doctors Wish List for Health Care Reform

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The Issue:  Health care costs too much.  

It should not be this way because true cost is typically far less than current charges. 

The Reason:  There is no price transparency, so patients are disconnected from costs.

Healthcare is inexpensive to deliver. It is everything that gets between the patient and the doctor that drives up costs – the hospital, the lack of competition, the red tape that doctors have to deal with that increases their overhead and takes them away from their patients, the high cost of drugs, defensive medicine, the “handcuffs” placed on doctors which prevents them from innovating and creating value. 

The current trend has driven doctors out of business. Almost 65% now work for hospitals. Over 15% of medical school graduates will not see a patient in their career. Doctors are burning out and retiring much earlier than ever before. Private practice of medicine is in grave danger.

What can be done to help patients and doctors and to drive down costs?

1. Enforce & strengthen the Primary Care Enhancement Act – uncouple HSAs from insurance so patients can use it for Direct Primary Care. Clarify DPC as a delivery model and not a risk bearing entity

2. Remove anti-physician provisions from ACA (surgery centers, ACOs, IPAB)

3. Relax/repeal Stark laws

4. Fix the Medicare payment system which reimburses hospitals more for services than those delivered outside of the hospital

5. Repeal MACRA

6. Repeal HITECH – these 2 laws have created unnecessary and burdensome regulation and red tape that are putting doctors out of business

7. Promote charity care with tax incentives to providers

8. Protect doctors and patients from having to participate in treatments that violates their conscience

State level issues critical to the overall goals

9. Protect doctors from predatory specialty societies who have colluded with hospitals and insurance companies and force them to pay money to “maintain their certification” (MOC) as conditions to work treating patients

10. Repeal Certificate of Need (CON) laws to foster competition/innovation

11. Meaningful Tort Reform which would put an end to “defensive medicine”

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