Pecos Bill is a mythical figure of American Folklore. I first learned of him in my doctor’s office. I was 7 years old, suffering from severe asthma, and Dr. Aaron Horland, an EENT (Eye, Ear, Nose, Throat) specialist in my home town of Newark, N.J., had agreed to reduce his fees so my mother could afford to provide me with the allergy shots that may well have saved my life.

Dr. Horland’s paneled waiting room displayed about half a dozen prints of larger-than-life figures from American Folklore, such as Paul Bunyan. Pecos Bill was among them, riding a wild Tornado. Realizing it could not throw him, the tornado ‘rained itself out’ over Arizona, creating the Grand Canyon in the wake of its flood waters, finally crashing into California to form Death Valley.

These days, most doctors feel as if they are riding a wild tornado each day of the week. (I would imagine that most well informed Americans feel the same way this year.) There is hardly a week that goes by without some new concern or demand, none of which have to do with learning about Medicine. We are caught up in a torrential whirlwind of bureaucratic regulations admixed with a flood of threats.

On June 14, the Maricopa County Medical Society of Arizona informed its members that The Centers for Medicare and Medicaid Services (CMS) are requiring doctors to enroll in a program called PECOS (the Provider, Enrollment, Chain and Ownership System) 6 months sooner than expected. Not only that, but CMS suddenly decided to change the rules of the game, and is not backing down even though the AMA (for once) and 40 other medical organizations contend that it is going “beyond what is called for in the health reform statute. According to the legislation…only physicians who order and refer durable medical equipment, prosthetics, orthotics and supplies, or home health services are required to be enrolled with Medicare through PECOS by July 1. However, CMS also is requiring that doctors who order or refer imaging, laboratory and specialist services be enrolled by July 6.”*

If I, as a dermatologist, do not enroll, and send a biopsy of a malignant melanoma to a trusted pathologist, that pathologist will not be paid. Ipso facto, that doctor will not provide his service to my patient.

The AAD contact person made it sound as if enrolling in PECOS just takes 5 minutes: ‘Filling out the form  is not a problem at all – it is just a way to be sure that no fraud or abuse occurs.’

BUT - if one comma is different between the Pecos form, the NPI form, and the IRS forms, I may not get paid!!

As Dr. Jane Orient wrote two days ago, “Containment efforts in new Medicare rules include requiring doctors to “revalidate” their billing privileges periodically. They’ll have to show that their name, address, identifying numbers, and organizational status are exactly as registered. They’ll have to give Medicare access to their checking account by electronic funds transfer (EFT) so that it can make immediate “adjustments” in case of overpayment.

The Patient Protections and Affordable Care Act (“ObamaCare”) imposes additional screening requirements; some providers will have to be fingerprinted. Ever-more aggressive private bounty hunters called Recovery Audit Contractors (RACs) are descending on doctors’ offices, dissecting claims and patients’ records, looking for a missing “bullet point” in the documentation, or an inaccurate digit in the billing code. ObamaCare increases the penalties for errors from $11,000 per item to $50,000. The government’s burden of proof, already light, has been further decreased. There is no need to prove any intent to defraud, or even to show that any money was ever collected.  Also, the definition of “fraud” is expanded to include “unnecessary” services, “ineffective” services, or those that don’t comply with Medicare requirements. “

Twila Brase, President of CitizensCouncilonHealthCare (www.healthcarefreedom.us) just visited Capitol Hill, where, to her surprise, she learned that  1) “no national physician organizations except for a national neurologist's group, are asking for a repeal of the [Obama Health Care] bill, which is frustrating to certain GOP Members of Congress, and 2) There is disagreement among Republicans over a straight REPEAL of ObamaCare or the proposed "REPEAL AND REPLACE" plan. She was told that if there is not agreement on a straight repeal, the law will likely stand intact and un-repealed. Keep this in mind when you next talk to your Members of Congress.”

[In addition, Ms. Brase discussed] “EHR [Electronic Health Records] - Tool for Control of Doctors. The Economic Stimulus law (ARRA), according to the Obama Administration, is the foundation for national health care. The bill requires every doctor and hospital to have an interoperable (online accessible/linkable) electronic health record system by 2015 if they want to avoid reduced Medicare payments.

It also envisions a single online medical record for all citizens, and provides $20 billion for the creation of a National Health Information Network (NHIN), which CCHC calls an InfoTRUSION network.”**

My own internist left his group practice when his partners decided to implement EHR. They went bankrupt in the process, but his practice is thriving.

THEN there is the Doctor ‘FIX.’ “ The Hill (5/21, Pecquet) notes, "Without the [Fix], payments to doctors under Medicare were scheduled to receive a 21.3 percent cut in June. Under the deal crafted by House Ways and Means Committee Chairman Sandy Levin (D-MI) and Senate Finance Committee Chairman Max Baucus (D-MT), the payment will increase by 1.3 percent through the end of the year." Doctors "would get an additional one percent increase in 2011, and further increases would be offered in 2012 and 2013 based on the growth in Medicare health spending." Kaiser Health News (5/20, Villegas) also covered the story.”

Fees have not kept up with inflation since the payment ‘system’ was introduced circa 1990, when they were actually rolled back to fees charged in the 70’s. Of course, expenses (staff salaries, rent, etc,. etc) are not Price-‘FIXED.’

"Kaiser Health News (6/15, Marcy, Villegas, Weaver)  GOP Unwilling To Pass "Doc Fix" Because AMA Supported Health Reform. Roll Call (6/16, Pierce, Roth) reports, "It's not that Senate Republicans aren't sympathetic to doctors' desire to get paid for their services; it's just that they aren't willing to bend over backward anymore to help the American Medical Association get the legislative remedy that it wants." The GOP "and the AMA used to be like peas in a pod -- such as in the early 2000s when the GOP had control of Congress and repeatedly pushed payout limits for medical malpractice lawsuits." In 2009, however, "the AMA did the unthinkable in Republican eyes and endorsed the Democrats' massive healthcare reform bill. So, as the Democratic-controlled Senate now debates a bill that would prevent physicians from taking a 21 percent cut in Medicare payments, Republicans are turning the other way."

I think you get the picture. We need to treat our patients. We should not make the practice of medicine subservient to, and secondary, to compliance with a non-stop flood of bureaucratic regulations. Practicing quality medicine should not place us at risk for fines, bankruptcy, and even potential imprisonment, for failing to ride the whirlwind - or by making a numerical error on a government form. 

We are Mad as Hell, and we’re not going to take it anymore. Is it time for us (patients and doctors alike) to Just Say NO?

I think the time to say ‘NO’ is way overdue. A strike (excluding emergencies) may well be the only answer - a vaccination causing a little, short-lived pain in order to prevent a fatal disease.

Tell your Congressmen and Senators to Repeal Obamacare  NOW.    ‘Replace’ in November!

Joseph M. Scherzer, M.D.

* News from Maricopa County Medical Society – Physician Deadline for Medicare PECOS enrollment moved up to July.”

** CCHC Health Care News - 6/15/10