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Monday, January 24, 2022

Federal participation in health care increases treatment options

‘Doctors can’t question the federal government. This is how health care works in the United States at the moment.’

Around the United States, in many cases, hospitalized COVID-19 patients have asked for ivermectin, but were refused the drug, and then followed a court order to force the hospital to provide the requested drug. demanded. Ivermectin, used safely in humans since 1985, has shown promise in treating viruses, especially when taken early. While this is an off-label use and not guaranteed to work every time, it is legal for doctors to prescribe ivermectin for COVID-19, and many patients, some desperate and dying, want to try it.

Why are so many hospitals resisting trying the safer, cheaper Ivermectin? The answer stems from a complex financial house of cards covering the entire health care system.

This is not the story of Ivermectin; It’s about what COVID-19 uncovered in America’s health care system. The federal government, pharmaceutical, and insurance companies hold the reins over what care hospital administrators can provide. They’ve never looked at your chart, but they have a role in your treatment, and doctors who deviate from administrative protocol may say goodbye to their careers.

Here’s a look at the many forces making health care decisions outside of the doctor-patient relationship.

sick people are profitable

Indiana-based Dr. Dan Stock is a family medicine physician with Frontline Doctors of America, a medical independence organization that promotes treatments such as Ivermectin for COVID-19. He says finance guides much of today’s health care landscape.

“Almost no one pays for direct care anymore,” Stock told The Epoch Times. “You pay for your care because you owe the federal government your money through taxes or through premiums to the insurance company.”

The insurance company or government purchases the service for you as a third party. That’s a problem, Stock says, because “the federal government has never paid its bills. Every doctor and every hospital loses money on every Medicare and Medicaid patient that comes to the door.” And making up the loss. For, he says, the cost of health care for those with private insurance is elevated.

A 2017 fact sheet prepared by the American Hospital Association states that the annual shortfall borne by hospitals is $57.8 billion, and privately insured patients and others make up the gap.

Nonprofit hospitals are federally required to accept Medicare, Medicaid, Retirees Military Insurance, Indian Health Services and all federal insurance programs.

This cost-shifting led to inflation of medical prices and increased private health insurance premiums.

“Employers started raving about it, people started giving up on their private insurance because it was no longer worth the money, so the Affordable Care Act got passed,” Stock said. “The idea was, look, market forces won’t tell you to join in and buy a third-party payment plan to keep Medicare and Medicaid afloat. Hospitals are screaming ‘We’re going to go bankrupt.’ So comes the Affordable Care Act, which says that everyone in the country has to buy insurance, and if you’re an employer, you have to buy it for your employee. You’re not allowed to say no. If you do If so, we make you a huge one.”

Stock says Medicare and Medicaid are kept funded.

“But there was a problem with the Affordable Care Act. They have this thing called the Medical Loss Ratio,” Stock said. “Someone in our federal government talking to these idiots said hey, if you were a private insurance company If you do, you will have to spend 80-85% premium on medical supplies and services. Only 15-20 per cent of this can be passed on to the shareholders or used to pay administrative fees.

By this rule, the insurance companies get more profit when the patients are sick.

For example, let’s say an insurance company plans to cover 100 patients with high blood pressure, and it plans to buy a certain blood pressure drug. It estimates how many doses these patients will use and negotiates price with the drug company.

“I’m not going to try and negotiate a lower price. I want the price to be higher because I’m going to keep 20 percent of what I buy for them,” Stock said. “The drug company is like, OK, I’ll sell you for a higher price. Now suppose two of those 100 patients start eating better and get rid of their high blood pressure. They don’t need the medicine anymore.” ” The insurance company budgeted earnings based on all the people who were sick. With two people off the drug, the company loses 2 percent of its projected profit, in this example.

“The insurance company would make more money if the population stayed sick and bought more goods. Let’s take the other side,” Stock said. “Let’s say 100 percent of those patients saw their blood pressure get worse. Now they need to take additional medication. I’m going to lose money because let’s say 90 percent of the premium I collected was high blood pressure. Now I am not going to make that much profit. Therefore, the insurance industry has become a pre-payment scheme for health care services and the way they maximize their income, That is don’t buy at low prices, buy at high prices and then force everyone to stay on budget.”

health care systems and codes

How do insurance companies predict the health of the public?

Electronic records developed nearly 20 years ago helped doctors track patient data such as sodium levels, blood sugar and kidney function. About five years later, the government realized that hospitals and independent doctors were tracking that information, but could not share the data with each other due to privacy regulations attached to the HIPAA law.

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That is why, in 2012, the Accountable Care Organization (ACO) was formed. The doctors and hospitals that have joined the ACO are now working for a large employer.

Medicare and Medicaid said that anyone who is not part of the ACO will have a 3 percent cut in reimbursement. The stock said it offered a 2 percent increase to those joining the ACO.

“You realize that margins are really narrow in medicine. Most hospitals have a margin of one or two percent,” Stock said.

“The federal government said then, to get to that 2 percent and maintain your reimbursement, you have to do two other things,” Stock said.

First, ACOs became obligated to use electronic medical records systems and report data back to the Fed and insurance companies.

The data doesn’t drill down to the level of “John Smith has asthma,” but does reveal what percentage of coronary artery disease patients are on a statin drug, or what percentage of people with COVID-19 are being treated with a respirator. Is.

To enter information into computer systems, doctors must link treatment to diagnosis. They must combine a current procedural terminology (CPT code) with the International Classification of Diseases (ICD Diagnostic Code).

“For example,” Stock said. “I am not allowed to just write someone a prescription for losartan. I have to write a prescription for losartan and link it to a diagnosis, in this case blood pressure, so that they can tell what I did.

To stray from the code is to write fraudulent records. If you give ivermectin it should be coded for its on-label use, for the treatment of parasites, not COVID-19.

Here’s the other thing the government says you’ll need to do to maintain your 2 percent reimbursement: The government and insurance companies pay for the performance plan, also known as the value-based program.

The Center for Medicare and Medicaid Services (CMS) website states, “These programs reward health care providers with incentive payments for the quality of care provided to people with Medicare.” “Our value-based programs are important because they are helping us to move towards payment providers based on quality rather than quantity of care delivered to patients.”

The CMS website lists “quality improvement organizations” that develop and implement these programs, including the National Quality Forum; Joint Commission for Accreditation of Health Care Organizations; National Committee for Quality Assurance; Health Care Research and Quality Agency; American Medical Association. Some of these groups are headed by former insurance, pharmaceutical or CMS executives.

Now the government, advised by insurance and drug companies, defines what makes a good medicine, Stock says. Doctors must diagnose and provide a protocol code of care.

CMS reimburses based on how well health care systems meet these guidelines.

Like social credit scores, individual health care providers are being scored by their performance.

“Every doctor, nurse practitioner, and physical therapist is a cost center for the hospital and the ACO knows how many referrals and how many lab tests they have contracted, and they know how much benefits individuals are getting from the insurance company, Stock said. “They’ll come and tell you verbally, they won’t put it on paper, but the administrators will show you how much money the ACO is making on you, how much you’re making, and they’ll get rid of you if you’re not profitable.”

New doctors could come out of college in $350,000 in debt. Old doctors may have kids in college. They sign a contract with a restrictive clause that states that if the ACO fires them, they must move 10-15 miles away from their practice or from all properties in the ACO.

“You have to be away for a year, sometimes two years, you’re not allowed to advertise in that exclusion zone, you’re not allowed to tell your patients where you’re going, you have to get a copy. of your chart with you. For every provider in medicine, our business is our patients’ trust in us and our advice, and now the ACO owns it, which means they own your business capital And they can bankrupt you,” Stock said. “And if they fire you because you’re not profitable, no other ACO wants you because they know you’re not profitable.”

training the next generation

The federal government has a program for new doctors with college loans. Work 10 years at the non-profit ACO and your loans are forgiven. That is, 10 years of following the protocol.

“If the doctors are not following it, the hospital and the ACO suffer financial loss. An ACO can easily go bankrupt because the margin is small and so they control what the doctor can study,” Stock said. “Now the doctor comes to work every day with a financial gun to his head. ‘If I don’t follow these protocols created by the federal government and insurance companies, I can be fired, so my family doesn’t make money. I go to study what the government and insurance company tell me to study for continuing education. I don’t need to think about myself. They are talking about the whole profession. They have been doing this for 15 years. These doctors are unable to think for themselves. Doctors cannot question the central government. How health care works in the United States at the moment.”

to follow

Beth Brelje is an investigative journalist covering the most interesting and sometimes elusive news from Pennsylvania politics, the courts and the Commonwealth. Send her your story ideas: [email protected]


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