No time to rest, Practicing Physicians! In the middle of COVID19 battle, we must take back medicine for patients first!!

Marion Mass, M.D. PPA co-founder

Patients… it’s always been about you!!! The physicians that are putting themselves in the line of #covid19 🦠fire, are here for you and working alongside bedside nurses, respiratory therapists and every hospital personnel in scrubs. High time we were all a #stewardofmedicine! 👩🏾‍⚕️👨‍⚕️🧬

Were you there when the battle cry, #givemePPE (more accurately, #giveUSPPE came out? It was a rally point!!

For decades, perverse incentives that allow the BIG corporate quasi-monopolies to prosper, have been making sure that you, America, PAY more💰💵 and get less in health care.
It’s time to realign incentives that promote inclusive stake-holding. This would mean more patients able to capture medical care at a lower dollar value, paying less for health care. It would mean more practicing physicians able to treat you, the patients as we were trained, making enough to pay back the dozen years+ of education needed to become a physician. More bedside Nurses and more Respiratory Therapists and Physical Therapists and others able to support their families.

This means fewer paper pushing middlemen who are offering little value. Put simply, they are represented by monopolized BIG companies (Pharmacy Benefit Managers, Group Purchasing Organizations, hospital systems, insurance companies, Health Care IT, and pharma,) are robbing America blind, and many are RESPONSIBLE for all of the delays in test kits in getting Protective gear #PPE, BIG companies have been medication hoarding, and offshoring supplies and drugs to China and other countries.

Three years ago when we opened up Practicing Physicians of America (PPA) at the Library of Congress, who knew that our band: Westby G. Fisher, Niran Al-Agba, Brian Jamal Dixon, Judith Thompson and Myself would be on the front lines of COVID19? https://practicingphysician.org/

Who knew that after writing the Free2Care White Paper Last year, the changes we (Myself, David Balat, Kimberly Legg Corba, Doc Nikki Johnson, Caren Gallaher, Twila Brase, Kris Held, Craig M. Wax, Robert Campbell and others suggested to multiple Senators, Congresspeople and other policy makers, would present themselves as being necessary to happen so now and for the next epidemic, medical care workers aren’t fighting a virus without gear and tests, and we, the #scrubs are leading and NOT the suits in the C suites.

PPA became a member group of the Free 2 Care Coalition http://free2care.org/ Free2Care is now 2 dozen groups, with now 3 million patients and 37,000 Physicians, about to expand to 60,000. We are aligned behind the ideas in our white paper, in the process of updating. The ideas that unite Free2 Care are patient centric, Physician/Patient relationship friendly, cost effective and non partisan. Paper can be accessed here: http://free2care.org/wp-content/uploads/2019/06/Free2care.pdf

Free2Care has invited collaboration for a year. Member groups include: Physicians4Patients (Caren Gallaher, Basia Jenkins, Doc Nikki Johnson) Physician Outlook (Marlene Smith ) Hope4Docs (Marnie McGrath) Physicians Working Together ( Doc K Jackson Christina Lang, Marie Jhin Lassila ) DPC Action (Kimberly Legg Corba, Katarina Lindley, Lee S. Gross, Josh Umbehr, Chad Savage) Association of Independent Doctors (Marni Jameson Carey) Patient Rights Advocate ( led by the late Great physician and Senator Dr Tom Coburn, who passed away today. May he, a tireless advocate and always a physician rest in Peace) AMAC (The late Dan Weber and his family, Andy Mangione Bob Carlestrom ) Patients Rising Now (Terry Merrill Wilcox) Citizens Health (John Chamberlain, Megan Janas, Brennen Hodge) The Job Creator’s Network, Physicians for Reform (C.L. Gray, Bev Gossage) Practicing Physicians of America, who is proud to be helped by Kenneth A. Fisher , Lia Huston, Mark Lopatin, Christina Dewey, Katherine Newland Barton, Roy Stoller, Susan M Hull, Mark Lopatin, Susan Brown, Holly Thacker, Rupali Chadha, Jessica Leigh, Mary Delila Tipton, Jamie Wells, Dana Corriel, Amaryllis Sanchez, Jayemzee Costello, Patricia Aronin Sherrill, Natalie Newman, Reese Tassey, Ed Gaines, Chris Sheeron, Phil Mandato, Christine L. Saba-Constantios, Phil Totonelly, Karladine Evelyn Graves, Meg Edison, Sheila A. Olive, Pastor Stephen Broden, Robert Arlett, K Kay Moody, John Radell, Amy Judice Townsend, Amy Zellers-Shrader, Joel Strom, Justice in Medicine, Joan Cullen, Sheila Page, Danae Powers, Michael DellaVecchia, Brian Sachs, Ayal Kaynan, Scott Hardeman, Robert Dean, Marcello Hochman, Marchelle, Gianni, Venu Julapalli, Holly Fritch, John Tomicki, and so so many more!!)

Free2Care Executive Director, David Balat does this PRO BONO, as do all of the PPA board, and almost all of the physicians in the Groups who participate including those mentioned above and more!!!

Invite your physician friends to join one of the Free2Care member groups, PPA is free. Patients can join Patients Rising or AMAC. Physicians can join PPA here: https://practicingphysician.org/join/

Together we have multiple connections to Senators, Congresspeople, HHS, CMS and the Administration, and among our member groups, we have been SHARING those connections. Just today, the Amazing Amy Mecozzi Cho, Daniel Choi, Jason Adler, and Julio Gonzalez were emailing a US Senator who immediately called CMS to 🔨 barriers to make sure patients get care and nurses and doctors were protected.

This is after a week of more physician heroes pulling bad Surprise Billing language out of the COVID bill (twice) and pulling language that restricts cost saving innovation models out of the COVID bill. Nothing like tweeting “Take the PORK out, Piggies” 🐷directly at multiple Senators. Take that!!!

Good citizen centric ideas belong to all of us. And congress, the president and EVERY elected official works FOR #WeThePeople!

no time to rest… #patientsfirst #takebackmedicine trust #scrubsNOTsuits first!

⌛️⏰Time is up!!

Happy National Physicians Week!! 🇺🇸💜❤️💗🇺🇸 and God Bless America!

PPA Joins Patients in Harrisburg to Advocate for Access to Meds

Marion Mass, M.D. asks lawmakers to “roll up their sleeves” and work with physicians on behalf of patients

Non medical switching happens when a patient is changed to a different medication because the PBM-imposed formularies, the drugs that are covered by insurers have changed. On Feb 18, 2020, PPA’s Marion Mass, MD stood beside patient advocates and gave testimony to The Consumer Affairs Committee of the Pa State House regarding Non Medical switching. Highlights below.

Mass’s testimony excerpts:

“I thank you for this opportunity to testify on behalf of Pennsylvania patients. Other than practicing as a pediatrician in Bucks and Montgomery County of Pennsylvania, I have no conflict of interest.  I paid my own way to come here today, as I do for every advocacy trip.

House Bill 853 is vital to protecting the health and well-being of patients, especially those with serious chronic medical problems. Patients, especially those with chronic illness and preexisting conditions,  deserve consistent benefits during the tenure of their insurance plans.

Let me start with a story.  Ryan was diagnosed with complex partial seizures at age 17, and for most of the last 20 years he has been well controlled on Topomax and Lamictal.  Initially, he had excellent coverage for brand names of both, but his out of pocket cost for the brand name shot up suddenly and unexpectedly to $320 for a 3 month supply, compared to $10 for the generic.   Ryan switched to generics three separate times during the middle of the policy year.  With two of the three switches, he suffered breakthrough seizures.  For those listening who are unaware, having a seizure not only is a life-threatening event while driving a car, or operating any mechanical or sharp implements, a breakthrough seizure prevents epilepsy sufferers from driving for 6 months.  He also suffered accentuated side effects of memory decline and dizziness, and intense worry of having a seizure at a dangerous time. These were affecting his personal and professional life.  Ryan is a staunch self advocate.  During the time of trying to advocate to get back on brand name, he suffered the disruptive and frustrating process of having to make multiple calls per week, lasting upwards of 30 minutes to his insurance company.  

There are 133,000 epileptic  patients in Pennsylvania.  There are 7.7 million patients with at least 1 chronic disease, and almost half of those have more than 1 chronic disease most necessitating medication. 

  Not all of those patients can advocate as well as Ryan.  Non-medical switching is dangerous to their health, and destructive to their well-being as well as their pocketbooks.

I have seen dozens of affected children personally and am here to tell this committee, and all of Pennsylvania that we must protect treatment decisions made between physicians and the patients for whom they care so that patients get the appropriate access that they deserve at a reasonable cost.

During the questioning, I am happy to reveal more specifically what I know regarding drug pricing, formulary switching and pharmacy benefit managers.  I can share citations from other states that have advanced legislation and have studies regarding the dangerous practice of non- medical switching.

For Pennsylvanians who are living with chronic health conditions, coverage changes allowed by non-medical switching can devastate health and finances. Coverage, when purchased, must remain fair and consistent –patients cannot change plans during the policy year, insurers should not be able to change formulary coverage during the policy year for treatments and services the patient is receiving. It’s time for this committee and all policy makers to think of patients first.  Just like you, did, physicians took an oath… ours was to protect patients.  Let’s roll up our sleeves and do that…. Together. ”

Angie Santiago, lead financial counselor, oncology, Thomas Jefferson University Hospitals, said her job includes helping patients understand what is covered by their health insurance as well as options for additional financial support. She noted that her hospital’s cancer center started having problems with non-medical switching about 18 months ago. She explained that non-medical switching allows insurers to re-categorize prescriptions as pharmacy benefits, requiring the prescription to be filled through a specialty pharmacy outside of the hospital. The switches are also able to occur in the middle of the plan year, preventing patients from switching their health plans, she said. She shared the story of one patient who had to change how he received and paid for his medicine in a few weeks in order to continue to receive his chemotherapy treatment. 

Robert Mentzer, advocate, shared his firsthand experience of non-medical switching when his daughter, who suffers from epilepsy, had her medication switched to a generic version, causing her to have a severe seizure. He explained that when his daughter’s medication was removed from coverage, his family had to choose to either switch to the generic version or pay the $3,250 out-of-pocket cost for the brand prescription. 

Sam Marshall, president and CEO, Insurance Federation of Pennsylvania, noted that health plans provide notice of any change in the drug formulary to allow a doctor to explain why the patient needs to remain on that particular medication. 

Arielle Chortanoff, government affairs director, Independence Blue Cross (IBX), said negative formulary changes are limited and require a 45-day notice to members with appeal rights available. . She noted that the bill fails to address the issue of cost

Dr. Mass said the amount of paperwork that patients and physicians receive from insurance companies and the process of completing these appeals take away from patient care. Chortanoff responded that insurers are developing tools to make it easier for physicians and patients to understand benefits and alleviate the paperwork burden. 

Rep. Oberlander asked Dr. Mass if she had any experience with issues related to diabetes. Dr. Mass said insulin is typically covered to treat diabetes. She added that there’s no transparency on the money flowing between pharmacy benefit managers and pharmaceutical companies despite Pa’s Auditor General Eugene DiPasquale asking for this transparency. Mass later pointed out that Pharmacy Benefit Managers(PBM) are now owned or own insurance companies, and that PBM in a shocking conflict of Interest have the right to receive money from drugmakers. “In any other industry, this would be a kickback” Mass stated. It would be illegal, but kickbacks are legal for PBM and their hospital counterparts the GPO.  

Rep. Neilson asked for more information on the panels making these decisions. Yantis said formulary changes are decided by a group of physicians and clinicians who meet quarterly to review drugs coming into the market and compare them to the drugs currently on the formulary to make recommendations to the Highmark pharmacy team on the best tier for that drug. Dr. Mass said large pharmacies like CVS own pharmacy benefit managers and could create their own panel (with in-house pharmacists) to make decisions. She again noted that pharmacy benefit managers are allowed to accept monetary remuneration from pharmaceutical manufacturers. Rep. Neilson asked if anything has been done legislatively to prescribe how those panels are put together. Yantis said they are put together based on best practices and not a state or federal regulation. 

Doug Furness, senior director of legislative and regulatory affairs, Capital Blue, and Michael Yantis, vice president of state government affairs, Highmark, also testified.

PPA Takes the Hill, Bi-Partisan Style!

Practicing Physicians of Americas cofounder Dr. Marion Mass teamed up with multiple grassroots physicians from around the country to discuss how to protect patients from surprise billing while retaining access to quality medical care. These physicians all paid their own way to come to DC .
Action items, and opportunities for you are coming soon!!! Let’s do this, let’s represent our patients and our profession!

Rep Roger Marshall, M.D., (KS) PPA co-founder Marion Mass, M.D. Rep Neal Dunn, M.D.(Fla) and David Balat MBA of Free2Care 

Reese Tassey, M.D. of Maryland , MPH, Amy Chu, M.D. of Minnesota , MBA and PPA’s Marion Mass, M.D., of Pennsylvania with Rep Dean Phillips of Minnesota 

Representative Cathy McMorris Rodgers of Washington State  with PPA’s Marion Mass, M.D.

Amy Mecozzi Chi, M.D. PPA’s Marion Mass, M.D. and Reese Tassey, M.D. meeting with Senator Tina Smith (Minnesota) staff

PPA’s Marion Mass, M.D. with Purvi Parikh, M.D., of New York and Amy Mecozzi Chu M.D. meeting with Senator Toomey ( Pa)  staff

Jason Adler, M.D., of Maryland Mike Murphy, M.D., of Maryland Carol Pak-Teng, M.D. of New Jersey and Reese Tassey, M.D. catch a break between the house and the senate. These stealth lobbyists needed some fresh air.

Sign to Support Price Transparency in Health Care

Marion Mass, M.D.

Cost transparency is the necessary first step in reducing the unsustainable growing cost of medical care. America is spending half of her tax dollars on health care . Hard working Americans wage growth is being gobbled up by out of pocket costs. Regardless of your personal views on President Trump, his Administration’s Executive Order on transparency will help drive down the cost of health care for ALL Americans. Transparency needs our support as those who run the show want to keep costs hidden. Some in the hospital industry whose cost increases outpace EVERY other sector, are fighting against transparency, teamed up with the health care insurance companies.

We invite YOU to join us in signing the letter below thanking President Trump and the Administration for their bold moves toward achieving real price transparency to create a trusted, functional market in healthcare. Sign at this link: https://actnow.io/DTEUKAo

Thank you to our friends at Patient Rights Advocate, Association of Independent Doctors and AMAC Action, all part of the Free2Care network alongside PPA, for this letter writing campaign.

The Practicing Physicians of America
February 2, 2020

Dear President Trump,

We are writing to thank you for the bold moves you and your Administration are making to bring transparency to healthcare. 

Please stay strong against the forces who want to keep the American people in the dark — blindfolded to know prices before we get care, held hostage without access to our complete health information, and having to pay for our healthcare with a blank check.

Healthcare is Americans’ number one concern. According to the 2019 Harvard Harris Poll, price transparency is a solution that 88 percent of Americans on both sides of the aisle agree on. Meanwhile, studies also show, fear of financial ruin is causing people to avoid seeking the healthcare they need, too often until it’s too late. 
 
Americans want and deserve full transparency. We want to know the real prices of healthcare before we receive it. We want to know the quality of the care available to us. We want easy, real-time, digital access to our complete health information including prices, clinical history, and payments. Currently, our opaque system makes all that impossible.
 
We, a cohort of Americans fighting for a better healthcare system, are so grateful that you and your Administration are courageously working to implement the bipartisan transparency laws that already exist. You are doing so despite strong resistance from the Healthcare Industrial Complex — hospitals, insurers, pharmaceutical companies, and the many middle players — who are all capitalizing on patients’ misfortunes.  

Your transparency and interoperability rules will restore Americans’ trust in our healthcare system. These rules will hold the healthcare industry accountable, cut out middle players, and greatly reduce healthcare costs and drug prices by ushering in competition, choice, and the ability for consumers to shop for the best care at the lowest possible price. 
 
Once we have systemwide healthcare price transparency, we will benefit from a functional healthcare market that operates on free-market principles. We will be able to buy healthcare the way we buy groceries or gasoline, clothing or cars. As healthcare prices plummet, wages and savings accounts will increase. By shining a light on hidden prices and quality information, you will put patients in control of their healthcare, and Americans will become healthier and wealthier. 
 
On behalf of patients, workers, seniors, employers and taxpayers, thank you again for taking these brave steps toward Making America’s Healthcare Great Again!
 

Speak on Trump’s Order on Price Transparency in Health Care by 1/29

PPA is encouraging that physicians and others comment to Health and Human Services regarding the Trump Administrations’ most recent Price transparency rule found here.

 This proposed rule complements a previous rule requiring hospitals to post their actual prices online and requiring insurers to disclose (in easy-to-understand format) the prices they now negotiate in secret with hospitals and other providers. The effect would be to enable patients to have some idea before they receive care of what they could end up owing to a provider after the care is delivered and the insurer has issued an Explanation of Benefits (EOB) showing what portion of the cost has been covered. This is a step toward pricing sanity in a more-competitive healthcare marketplace because it supports informed shopping by consumers of medical services. The intent is to enlist and boost the power of consumers in driving down prices.

It is crucial for physicians and patients to comment, as the insurance and hospital industry have come out in full force supporting the now hidden prices that have allowed these two industries to profit themselves while gouging Americans.   This is especially true of the most consolidated hospital systems and dominant insurance companies who use opacity combined with their respective market shares to continually drive prices up.  They simply have no incentive to lower prices. 

PPA’s full comments are below.  You are welcome to copy and paste them in part or whole.  When commenting, adding your personal story regarding how patients are hurt by opaque prices.  

For ease, you can consider copying and pasting a personalized form of these italicized comments: firmly support the current efforts to bring the prices of medical services and procedures into the open and to make those prices easily accessible to our patients—in short, to replace price opacity with price transparency.

Noting that in the proposed rule, HHS also requested comments regarding how to enact transparency of quality, I request transparency in the level of the training attained by those who deliver care, and full disclosure of conflicts of interests of any person or organization the government relies on to define or implement quality in health care.

SUBJECT: CMS-9915-P, Comment on the Proposed Rule Mandating Price Transparency

Ending price OPACITY in favor of price TRANSPARENCY is critical to driving down the costs of all forms of medical care in America.

Practicing Physicians of America (PPA)—a non-profit organization representing thousands of physicians, and a part of the Free-to-Care Coalition, now comprised of 37,000 physicians and 3 million citizens—declare their firm support for the proposed rule requiring insurers to reveal the prices they negotiate with all providers of medical care.

Why Transparency is So Sorely Needed

Each day, the thousands of physicians represented by PPA see the pain in the pocketbook of our patients. We see their foremost concern when they seek medical care. What will this cost?

We have observed our patients incurring higher out-of-pocket costs for health insurance (which ought NEVER to be confused with actual healthcare) that outpace their wage increases and threaten the financial viability of their households. 

More than ever before, the patients we treat in our offices are looking for an accessible, easy-to-understand way to shop for the medical services they need and to control their medical expenses. They would like also to see the exposure and defeat of the hidden forces that drive the relentless rise in premiums in response to excessive costs routinely obscured under the third-party payer system that has dominated American healthcare for close to 50 years and been an engine of our stratospheric rates of inflation in the cost of healthcare.

Price opacity, which has enabled forms of price gouging, has produced the environment we see today in which one in five Americans have had medical bills turned over to collection agencies.

This country desperately needs informed consumers of medical services who have choices at their disposal. Price opacity abets ignorance. Price transparency would vindicate the axiom of Francis Bacon: Nam et ipsa scientia potestas est. (Knowledge is power.) The informed consumer who is capable of making choices in a free marketplace that has been disciplined by competition is the only reliable force for driving down deductibles, premiums, and other costs. 

Do the lobbyists of the health insurance and corporate hospital industries resist calls for the end of opacity and the introduction of transparency? Of course they do. They’ll move heaven and earth to keep the good thing going that has fattened their coffers at the expense of the American patient. Those administrator-heavy industries drive inflation in healthcare by every means our current system has legitimized.

Consider the following.

For certain services and procedures provided on an inpatient basis, hospital charges grew by 42% over the eight-year period from 2007 to 2014.

Similarly, for hospital-based, outpatient care involving the same services and procedures, charges increased by 25%.

The charges for the same services and procedures provided by independent physicians grew by only 6% over the same eight-year period.

Those figures are drawn from a study of insurance claims data by the Health Care Cost Institute that has been the subject of reports in the last year.

Meanwhile, as the resources of the American consumer of medical care are relentlessly squeezed, the profitability of the health insurance industry is a picture of robust financial health

The health insurance and corporate hospital industries benefit from the price opacity that has become the sine qua non of the wildly inflationary, third-party payer system that has dominated the landscape of American healthcare for a half-century.

This scandalous gravy train operating under cover of law and public policy must be halted. Transparency is the brake to do the job. 

Those who enact national policy via regulation need to think FIRST of the needs of American patients and to tell the lobbyists of the health insurance and corporate hospital industries that they will no longer be permitted to be the dominating, decisive voices in the room.

On Quality

In inviting comment, the Departments have raised also the question of how Americans can shop on an informed basis for medical care of high quality that is affordable.

Yes, quality can be hard to define and quantify… although most people recognize it when they see it and can distinguish differences in quality when they experience them.

PPA offers this counsel. If the Departments are contemplating a forum of stakeholders to explore the question of quality in healthcare, it would be essential that any such forum be composed of the full range of stakeholders, most heavily represented by patients and the physicians who deal with them directly and personally.

When it comes to physicians, a “quality forum” should include not only physicians employed by corporations but also independent physicians.

When it comes to hospitals, a “quality forum” should include not only the urban, the regional, the large, and the corporate, but also the smaller, the rural, and the independent.

In addition, the representatives of stakeholders participating in any such forum on quality must be required to declare the interests they represent. The interest of the wider public, American patients—who seek to maintain their choices while simultaneously looking for relief from the high costs related to the medical care they receive and the insurance they carry as a hedge against catastrophic costs—  must be protected from the special and narrow interests that have greatly profited under the current inflationary, increasingly consolidated, increasingly corporatized system that has sprung up and flourished under a system of opacity.

“Quality” as a Function of the Practitioner’s Training 

As shown by surveys over the last decade, one measure for enhancing patients’ recognition of quality would be mandating transparency regarding the level of training acquired by medical practitioners. As the numbers of nurse practitioners and physician’s assistants have grown over a period that has seen some states allow nurse practitioners to “practice” as the functional equivalent of physicians, patients have experienced increasing confusion over who is delivering their care.

There is a vast gulf between the minimum 15,000 hours of clinical experience needed to become a physician and the 500 or 1,000 clinical shadowing hours needed to qualify as a nurse practitioner, or the 2,000 clinical hours required of a physician’s assistant. Given the obvious disparity in-depth and quality of training for these levels of medical practitioner, patients deserve to know the degree of training experienced by their caregivers, and they deserve the freedom to seek care from practitioners of their choosing.

Requiring hospitals and clinics to post prominently the levels of training of all practitioners is a simple step toward transparency. It will minimize confusion and strengthen the ability of the American patient to identify quality. 

Conclusion

Regarding Transparency. PPA firmly supports the current efforts to bring the prices of medical services and procedures into the open and to make those prices easily accessible to our patients—in short, to replace price opacity with price transparency.

Regarding Quality. We counsel that the Departments, in addressing the question of quality, whether by a forum or some other means, seek input from a range of stakeholders, and most particularly from patients and physicians. The Departments must be acutely conscious of the interests and agendas that inform what stakeholders have to say. The Departments should also never lose sight of the inescapable reality that any regulatory mandates on information-gathering that can be predicted to add to the administrative overhead already encumbering the practice of medicine in the United States will be at odds with efforts to create a freer, more-competitive marketplace in which prices can be first be expected to stop rising, and then proceed to fall.

Lastly, PPA calls for transparency in the level of the training attained by those who deliver care.