Home Forums Discussions General Discussion Sermo Grass Roots Letter to Congress!

On Sermo there is a grass roots movement to see if we can somehow make Congress better aware of the general plight of physicians "in the treches". Here are the important URLs:

* emrupdate review of the 2 threads dealing with this letter, skipping the numerous junk answers- http://www.emrupdate.com/forums/t/13093.aspx

* The actual Sermo thread that is still open (round 1 has closed and is continued here)- https://md.sermo.com/medical/ticket/details?nav=on&id=17083

We need for you all to be active! Here is my most recent reply on amending the letter:

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Folks, let's get back to the original intention of the thread!

In terms of the original letter, I would both simplify (esp get rid of point # 1), make the points more precise, and tell Congress what needs to be done:

1. The free market forces that have made this country great are not operating inhealthcare.
FIX: Congress should repeal the McCarran-Ferguson Act of 1945 which granted health insurance companies exemption from some federal antitrust statutes to the extent that it is regulated by the states. The exemption primarily applies to gathering data in concert for the purpose of ratemaking. Otherwise, antitrust laws would have prohibited insurers from boycotting, acting coercively, restraining trade, or violating the Sherman or Clayton Acts.
URL: http://insurance.cch.com/RUPPS/mccarran-ferguson-act.htm

2. Insurance companies increasingly dictate treatments we can provide andhave compromised our ability make the best decisions about your healthcare.
FIX: Congress should propose a bill that would grant antitrust exemptions to self-employed health care professionals to negotiate collectively with health plans, while prohibiting strikes. Such a bill was proposed in 1999, but to date has been defeated.
URL: http://www.physiciansnews.com/cover/1199.html

3. An excessively litigious environment has promoted the practice of "defensive" medicine.
FIX: Congress should forward malpractice/tort reform immediately.
URL: http://en.wikipedia.org/wiki/Tort_reform

Keep it simple- remember that Congressmen have very busy schedules and short attention spans!

Cheers,
Al

Al,
I like everything you said except for the lack of a strike. I am a member of organized labor and without the right to strike you are a toothless tiger my friend. They hurt cops and teachers with this garbage all the time. They get hit with the loss of two days pay for every day out on strike. Now that is BullCCHIT.

Let the docs who are on staff as management man the ER's at the hospitals for crisis care while the majority are out on the picket lines. Let them try and bribe some scabs who will be scared to cross the line or know that their own names will be mud if they do. Let them force the slave residence to cover everything. It is the loss of revenue, loss of customer access to the product or service that finally brings both sides to the table, plain and simple.

If you can't actually leverage back, then what reason does the other party have to come back to the table and negotiate "In good faith"??? None what so ever, trust me on this one. The history of labor is full of examples for this. Recently I was offered a job as a labor organizer with the new teamsters doctor's local here in CNY and I balked because I need to keep this place going for my wife and family. Some times I want to kick myself in the butt for this as I really think this is where I belong. I actually took organizing courses years ago down near you at the George Meanie labor center in Maryland. Again I don't say this lightly. We are consumers of healthcare too. But without both sides being able to leverage the other with financial losses then things never seem to move along. That is the real purpose of the strike. The withholding of services until we can work things out.

Two: I really think it is time for specialties such as all PCP's and other mostly office visit specialties to have their own unique fee schedule that gives their E&M codes and other office visit type things a relative value that is equal or better than the highest valued procedures. We all know that this is where the rubber meets the road. It is the FP like my wife that has multiple issues and meds to balance and deal with that take over half an hour plus paperwork to do, that under the present coding system one can't even get $100 bucks for here in a region like ours, even from comercial payors. What garbage. We need a separate fee schedule for the specialties that have no real surgeries or other high paying procedures to balance out their bottom line.

We almost have no Diabetes specialty groups to send hard to maintain and treat patients to anymore around here. Almost all of them have closed up shop and the last one or two are booked 4-6 months out! These Endo guys are just like PCP's in that most of their work is in low paying E&M office visits yet this is where we save tons of money for everyone by saving people and their body parts from failure and death. It is time to put up or shut up. The last Endo group to close shop claims they lost $300K over the last few years and had no choice but to close their doors. And this for caring and giving high quality time consuming care!

And on this we need a law that mandates the payment for any and all paperwork, referals, prior auths, even Rx's. Same with any and all forms for anything, school, work, what ever. Writing an Rx is not a mindless matter. It is the actual thought about patient and conditions and other meds. The faxing, calling, mailing and all the rest. No lawyer wouldn't think of billing folks for their para-legals time and their interactions with that para-legal.

Think about it... Why do we do tons of uncompensated paperwork for all these people? It is my contention that once the carriers actually had to cover the cost of what they push and shove on us, they would start thinking twice about how and what they ask for. As long as they can mandate that it be done for free, then they will continue to ask for the sky and beyond.

Al,
I went to the sign in for the link. I do most of the political activity around here. Can I as the practice manager join for real as opposed to pretending to be my wife? Also, how can I contact this great guy myself?

It is so nice to have your involved and active voice here on our board. Keep up the good work and thanks for keeping us all in the loop...

Paul

Paul:

Little secret- the Sermo "alborg" is about 4 people. Why do you think that I'm now #19 out of more than 900 oncologists even though I spent most of February off? Graham, from emrupdate, is all over the place there, posting provocative posts.

Post under her name- her rank will go UP!!! You should log on and add to the letter about the right to strike- that would be an excellent add-on point. I can't believe that I missed that.

Most laws depriving physicians the ability to collectively strike are codefied into various state laws as shown by this one in Texas- http://caselaw.lp.findlaw.com/txcodes/i1.001.00.000029.00.html
You might need to mention the fix, which is for federal legislation to allow physicians to strike, sort of a Rowe vs. Wade for physician collective action against insurance companies!

I feel for the endos- I too have pretty much shut down my oncology practice. I only do bare bone chemos, and that will eventually end too by the end of the year. They don't pay enough for caring for those high-risk time consuming cases!

Cheers,
Al

Actually, the "alborg" ranking has improved in the past 24 hours now that I'm posting:

805th out of 53829 overall;
20th out of 1015 in Hematology/Oncology

Paul- don't you and your wife bump alborg!!!

No Al I wouldn't dream of it. We "Bump" eachother instead.... Hee, hee, hee...

As cat owners we use the word bump quite a bit. The way they rub their cheeks against you sometimes almost standing up and slamming into you. We affectionately call those "Bumps".

But to get back on point; yes the right to strike or otherwise withold services is key. Without it you are not much stronger than before your right to bargin collectively. We here in America have a fairly sad history of organized labor and it didn't just start when "Ronnie" when he went after the air traffic controllers, it has been pretty bad for a long time, from the very begining.

I just have to laugh when I hear politicos and talking heads talking about finally get tough on trade (fair trade instead of screw us all down the river free trade). Insisting on things like the right to organize, our laws suck big time, we have just about emasculated our organized labor here in the US. So, although I agree with the idea in theory, we here must get our own house in order first. Who the hell are we to talk. He who lives in a glass house, right?

Got a lot to do this weekend but I will try and do some of the posting and reading you suggested in the next few days.

New link about the committee to write the letter-

https://md.sermo.com/medical/ticket/details?id=17464

The actual letter link-

http://writer.zoho.com/public/khozin/Open-Letter1

They are going for 50000 signatures!

Does this subject not stir up anyone else besides me and Al??? Where are my bold and let's fight back friends out there? Come on folks! Al is pointing the way, let's all say thanks to him by all of us getting in here and linking to his links and writing and signing on....

Doesn' the carriers having this anti-free trade wavier all these years that has given them such an unfair advantage over both patients and provider just make your blood boil??? It sure makes my blood boil. Amazing how congress always seems to give these really large well to do industries these waivers all while not recipricating and giving their workers (Docs, Baseball players as an example) or their customers (patients, ticket holders and fans) the same so that the playing field is at least some what level.

Why has not the AMA been screaming about this from the get go??? This sounds like the perfect place for a class action suit for patients, employers and other purchasers of health insurance and doctors combined as one force fighting to even out the leverage here. I'll tell ya the AMA and the Medical Societies should be ashamed of themselves over this alone. Where the hell have they been? This would seem so simple and the most appropriate way to break this strangle hold.

Me personally: Thanks Al for sharing, your knowledge and insight is very needed and valuable to me. Anybody else here???

Good Night and Good Luck;
Paul

I agree, Paul. There is a lot of complacency out there. Here at the AC site, though, folks are pretty psyched. One of the reasons that I like visiting the AC forums is that you guys are generally more motivated and active and I have a lot more in common since my EMR has many of the same issues as AC.

At emrupdate they are suddenly more CCHIT-aware, BTW. Notice that in the general posting forum they have now suddenly stickied my listing of anti-CCHIT activities when the reason why they banished me was the anti-CCHIT activities!

The good thing is that Sermonians have taken the initiative to do this letter. I've told them that I'm always willing to help if needed.