Last Updated: Mar 27, 2019
By Michael D. I. Siget, JD, MPA, PAMED’s Legislative & Regulatory Counsel
With the start of a new legislative session, numerous bills have been filed that may affect physicians across the Commonwealth. In Part II of Bills on the Hill, we will focus on telemedicine; any willing providers; tiered providers; CRNPs; POLST; CRNAs; assault against a health care practitioner; and optometrists.
You can access Part I of Bills on the Hill here to read about immunizations by pharmacists; continuing education for Lyme disease and other tick-borne diseases; informed consent for vaccinations; credentialing; restrictive covenants not to compete for employees of purely public charities; and non-compete clauses in physician contracts.
If you are interested in following the progress of these bills and other legislation that the Pennsylvania Medical Society (PAMED) has designated as high priority, you can do so by linking to PAMED’s new Legislative Update webpage. You can read more about this new feature here.
Please ask the Legislators to differentiate between Physicians and Providers and Nurses and Assistants by both quality and pay.
The Nazi's tried to call the Jewish Physicians "Providers". Here is a very good article called. "If you call me a "Provider I will assume you are a Nazi"
Lets make sure laws differentiate between the care a Physician provides and the care a Nurse or Physicians Assistant provides by pay.
Transparency in Quality and Pricing is important and differentiation for real quality is needed not meaningless metrics.
A physicians Assistant in another State recently placed a dialysis catheter into the carotid artery rather than the Jugular vein.
Was the patient given an option to have a Physician place the catheter? Did the patient pay less for a cheaper person to do it?
Do corporations and hospitals and CVS make more money by hiring mid levels to do the job a Physician should?
Do Legislators go along because they get lots of political donations from such entities as PBM's and GPO's like CVS and Vizient and others?
Do all these systems work at the expenses of the poor and sick to make corporations wealthy?
Should physicians be compensated for taking liability and active oversight like tele-medicine that can be used to supervise nurses and assistants in real-time?
Why did CMS change payment scales.
CVS needs to employ nurses to make the Aetna merger more profitable and Aetna can pay itself by having CVS take over primary care than paying independent physicians. Not having physicians around by telemedicine means more money for CVS and more liability transfer via contract law?
Seen in that light attached are the CMS changes propose for 2019.
CVS Payment changes needed : Pay lots for low level follow-up care and little for complex care.
Physicians pay for seeing more difficult level 5 patients will fall substantially while Nurses seeing low level patients will increase dramatically, almost double. More money for CVS and hosptials who employ them and CMS proposed changes play right into this scheme!
These changes may be devastating to primary care physicians.
We know that in CVS current proposed scheme, supervisory physicians don’t see the patient nor contribute in real time positively toward patient care yet take money and liability via Contract law will be sued preferentially by attorney’s and jury’s will be sympathetic. Cases will settle as indefensible by the physician.
Patients would be paying more for a lower standard of care. Note that additional legislation is proposed that allows CVS to be paid with money from HAS’s ie Cash!
HR 5138 and 6199 and more.
Suggested fix is to pass the tele-medicine bill and allow physicians to oversee in real-time all Physicians Assistants and Nurse Practitioners. After the Nurse or Phys Asst. sees the patient , ideally, the doctor reviews the electronic record and finishes he diagnosis. This would allow all Americans to access physicians and not just their assistants or nurse practitioners.
Convenience will force patients to use these CVS Aetna Minute clinics preferentially over more knowledgeable independent Physicians. Note that that US HR 5138(HYPERLINK "https://www.govtrack.us/congress/bills/115/hr5138/text/ih"https://www.govtrack.us/congress/bills/115/hr5138/text/ih) in the US Congress, would have incentivize use of the Minute Clinics over Physicians’ offices, for the bill preferentially allows patients to pay such Assistants and or Nurse Practitioners who work in CVS Minute Clinics with their Health Savings Accounts (HSA’s) while not allowing Direct Primary Care Physicians or Physicians in their offices similar ability to be paid with HSA’s. This would have further push primary care toward CVS/Aetna Minute clinics. Although support for this particular bill has waned similar bills limit patients use of HAS's for care provided by Physicians and free market pricing systems and push patients toward care provide by clinics associated with outpatient pharmacies.
This is the future of the full-on Corporate Practice of Primary Care in by insurance companies and middlemen PBM. We must speak up against the corporate practice of medicine which places profit over patient care and transparency.
It appears that funding via CMS as well as the legalized kickbacks offered to the PBM’s and GPO's favors the finances of the PBM’s/GPO's in their quest to assume control of health care and rake in corporate profits on the backs of the unsuspecting elderly and poor of the United States who will soon walk into CVS and be cared for by those with a fraction of training of a physician, while having their insurance company reimburse CVS more money for a low level visit while decreasing pay to those who see the complicated high complexity chronic patients in their private offices.
The time is now to call out CVS and their lobbyists; the true architects of the PBM/GPO kickbacks, the mergers of the health insurance companies and vertical integration and now the increased remuneration for basic low-level office visits and the preferential payments of CVS with cash from patients directly from their Health Savings Accounts.
CVS will rake in the cash while Physicians will be bankrupted and have to take all the liability.
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