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CCHF Health Freedom eNews

October 17, 2012

President's Commentary

Three liberals are right. Pay-for-performance (P4P) in health care could backfire. Pay-for-performance refers to financial incentives that reward doctors, hospitals and others for achieving the objectives of payers (insurers and government), such as efficiency, submission of data, and improved quality as defined by the payer.

P4P is the basis of almost all current health care reform. However, if the studies are correct, P4P will undermine patient care, eviscerate excellence, diminish interest in medicine as a career, and demoralize doctors and nurses.

The Health Affairs blog written by  three liberals asserts, "monetary rewards can undermine motivation and worsen performance on cognitively complex and intrinsically rewarding work, suggesting that P4P may backfire." They point out 128 studies as just a sample of many other studies that say so. 

Yet both presidential candidates support P4P. Each has supported payment to physicians based on physician compliance with government-devised standards of "value" (Obama) and "quality" (Romney).  

In January 2015, Obamacare will begin, "Paying Physicians Based on Value Not Volume," according to the HHS timeline for the ACA. Also, a new Obamacare P4P program will not pay for any Medicare readmissions if they occur within 30 days. 

Meanwhile,  RomneyCare hospital payments are "contingent upon hospital adherence to quality standards and achievement of performance benchmarks...." These benchmarks must "advance a common national framework for quality measurement and reporting..." [emphasis added]. All "insurers and health care providers shall submit data" to the State, with a penalty of up to $50,000 for failure to do so.

New studies agree. P4P doesn't work. Last year, a Health Services Research paper reported, "Despite offering substantial financial incentives, the MassHealth P4P program  did not improve quality in the first years of implementation." Then last week, researchers reported that a four-year P4P program  has not worked to decrease hospital-acquired infections. Yet, The Wall Street Journal reported Monday that "U.S. Ties Hospital Payments to Making Patients Happy." In search of high patient satisfaction scores to show to Medicare, hospitals have added ESPN to televisions and salmon to menus.

P4P sounds like a good idea, but it isn't. Alfie Kohn's excellent 1993 book,  "Punished by Rewards," quotes the legendary statistical consultant W. Edwards Deming who called merit pay systems, "the most powerful inhibitor to quality and productivity in the Western world" [emphasis added]. Deming further said it, "nourishes short-term performance, annihilates long-term planning, builds fear, demolishes teamwork, nourishes rivalry and...leaves people bitter." 

P4P is a disaster in the making for American medicine. So is Obama's plan to turn all doctors into employees paid by people and companies who aren't you and don't have your interests or health in mind. If you want excellence and individualized care, you will have to pay the doctor for it. Let me suggest that you find that doctor now. When you or a family member is sick or injured, you'll want to already have a doctor who you can trust to provide you with the customized care and individualized attention you need.

Now on to the news . . .

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News to Know:

Death by Doctor on Ballot

Massachusetts will vote on "Question 2" to allow doctors to prescribe overdoses of legal drugs for assisted suicide. The Massachusetts ballot question never mentions the word suicide: "A YES VOTE would enact the proposed law allowing a physician licensed in Massachusetts to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person's life." Exactly what are those "certain conditions"?

Father Tadeusz Pacholzyk, from the National Catholic Bioethics Center, asks in The Wall Street Journal why doctors should be the only ones sanctioned to undermine public trust in their profession and deal in death. Why not police with guns or lifeguards with millstones? Thaddeus M. Bort, M.D. comments on the article: "Over the past three decades I never had a patient whose pain could not be ameliorated by legal doses of analgesics. I...stand beside my oath: Primum non nocere" (First, do no harm). An online commenter, Claire O'Connor writes, "Tyrants throughout history have given millions of people the 'right to die'; what they denied them was the right to live." Could Massachusetts' new health care "cost containment" law with $500,000 fines for spending too much providing care in any given year exert pressure on patients to die?

Exchanges = End of Employer Coverage?

Will the government-established health insurance exchanges lead to the demise of employer-sponsored coverage? This was the question asked by Paul Keckley, Executive Director of the Deloitte Center for Health Solutions, during an October 9 webinar. He and Paul Lambdin, director of Deloitte Consulting LLP, according to the October 11 Bloomberg BNA health care  blog, "agreed that, based on simple math, employers would seem to have every reason to drop health insurance coverage for employees and send them to the exchanges." The article also notes, "Young, healthy people who currently have coverage are likely to face sticker shock if they have to buy exchange policies due to ACA requirements for age rating, "essential health benefits," and out-of-pocket limits, Lambdin said." Bottomline: more citizens will be forced to buy higher-cost government-issued policies.

Stopping the Secretary

Last week, AMAC announced support for the  SCOPE Act, which stands for "Safeguarding Care of Patients Everywhere." H.R. 6320, authored by Congressman Phil Gingrey (R-GA), a physician, would repeal a section of Obamacare that authorizes the Secretary of Health and Human Services to define "quality care" and prohibit health plans from contracting with doctors that don't meet the Secretary's idea of "quality." The Act's purpose "is to remove from the Secretary such improper authority, which presents a threat to the  Health and welfare of patients in the United States." 

AMAC, the Association of Mature American Citizens (AMAC), is a conservative alternative to the liberal AARP. It lists 460,000 members. The AMAC letter says, "The SCOPE act justly repeals section 1311(h) of the PPACA -- a section in the law that gives extremely broad authority to the Secretary of Health and Human Services to determine what constitutes quality care, and to essentially dictate how physicians practice medicine in the United States."

Gene Revolution or Genetic Revolt?

Some scientists and others are making plans to recreate the human race. Most people have no idea that these ideas exist or that they get published. Here are a few revelations that may make you wonder if, "there ought to be a law":

  • "Whole genome sequencing reveals the genetic blueprint for a person, generating information on every gene..." - Privacy and Progress in Whole Genome Sequencing, Presidential Commission, October 2012.

  • The price of sequencing a whole genome...will be less expensive than to perform a few individual genetic tests... and [this] information can be  stored in a patient's medical records." - Privacy and Progress in Whole Genome Sequencing, Presidential Commission, October 2012.

  • "We should use the emerging knowledge from genetics to have not just healthier children, but  children with better genes. We should give chance a helping hand." - Julian Savulescu, bioethicist, Oxford University.

  • "I think  choosing between embryos is not discriminating against people. It's deciding what child to have in the future." - Julian Savulescu, bioethicist, Oxford University.

  • "Transhumanism of a sort is implicit in much of the research agenda of contemporary biomedicine. - Francis Fukyyama, professor, Johns Hopkins School of Advanced International Studies.

  • "It is reasonable to think that the creation of  post-persons will leave mere persons more likely to suffer significant harms," - Nicholas Agar, Victoria University, Wellington, NZ

  • "If we do not develop [a humility concerning our human nature] soon, we may unwittingly invite the transhumanists to deface humanity with their  genetic bulldozers and psychotropic shopping malls." - Francis Fukyyama, professor, Johns Hopkins School of Advanced International Studies.

Quotes of the Week:


"Security isn't an IT problem, it's a people problem." - James P. Sheldon-Dean, Lewis Creek Systems LLC, "Security Expert Says Many Hospitals Would Fail Audits Due to Compliance Gaps," Bloomberg BNA, 10/8/12.









"We found broad non-compliance [with the HIPAA privacy rule], close to 80 or 90 percent. That was really eye-opening for me." - Michael D. Ebert, KPMG, "HIPAA Compliance Requires Robust Risk Assessment, Audit Contractor Says," Bloomberg BNA, 10/8/12.







"Nationwide healthcare transformation is virtually impossible without meaningful, system-wide adoption of EHRs and HIE, including a technologically advanced nationwide patient data matching strategy." - Recommendation to Congress on electronic health records and health information exchanges, Ask #1, HIMSS, September 2012.

Stats of the Week:

$17.7M - dollars spent from Obamacare Prevention and Public Health Fund for "Obesity Media Activities."

90 - percent of health care organizations out of compliance with the federal HIPAA privacy rule. (BNA Health IT Law and Industry Report, October 8, 0212 - subscription required).

75 - percent of clinicians that have reported multiple errors in electronic health records (BNA Health IT Law and Industry Report, October 8, 0212 - subscription required).

250 - number of Health Information Exchanges (HIEs), including 160 private HIEs.

< 60 - percent of HIEs actually exchanging patient data (only 40% of these receive sufficient revenue to cover expenses).

News Release of the Week:

As Candidates Debate Healthcare Issues, CCHF Predicts Patient Difficulty in Accessing Care

ST. PAUL, Minn. - The Vice Presidential candidates came out swinging with regard to Medicare, each trying to declare their plan is more realistic and workable for American citizens. They debated whether the Medicare piggy bank had been raided to help pay for the President's Affordable Care Act law.

As the ACA continues to be implemented, patient privacy is one of the most oft-noted concerns as data is forced online, but the law's impact on patient access to care is critical. The Citizens' Council for Health Freedom (CCHF) predicts, based on the results of a new study, that patients will have difficulty accessing medical care. Continue reading

Featured Health Freedom Minute:

Obama's IRS Enforcer is Coming Out

Under Obamacare, youʼll be thinking about the IRS all year long. Youʼll have to check in online when you change jobs, have a baby, marry, or change your income. Depending on these changes you may have to pay a higher penalty for being uninsured or pay back part or all of your taxpayer-funded federal premium subsidy for buying insurance. Continue reading

Twila Brase broadcasts a daily, 60-second radio feature, Health Freedom Minute, which brings health care issues to light for the American public. Health Freedom Minute airs on the entire American Family Radio Network, with more than 150 stations nationwide in addition to Bott Radio Network with over 80 stations nationwide.

Click here to listen to this week's features.

Citizens' Council for Health Freedom
161 St. Anthony Avenue, Ste 923
St. Paul, MN 55103
Phone: 651.646.8935 • Fax: 651.646.0100

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