The Declaration of Medical Independence (Second Level Appeal)
For today? It is our Independence Day
What follows is a line by line rewrite of the Declaration of Independence. It’s a celebration of both the founding of the United States of America and the July 1st CMS update —campaigned for by
, FCTMSS, DFAACAP—for an incremental change in the rules around TMS billing and coding. As of July 1, it’s now possible to bill up to 2 TMS codes a day, not just one, as had been the case. It’s not 10 a day, but it’s something. As one note, our founders loved long, compound sentences and somewhat chaotic capitalization. Without further delay, The Frontier Psychiatrists celebrates our Independence Day.In American Healthcare, July 4, 2024
The unanimous Declaration of the remaining 5 or so independent interventional psychiatric practices in America, when in the Course of medical practice, it becomes necessary for one medical specialty to dissolve the existing contractual limitations that have connected them via Change Healthcare’s ConnectCenter with third-party payers, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and the associate rate card entitle them, with some Modicum of respect to the Relative Value of mankind’s time, requires that they should declare the CPT codes with which they will deliver medically necessary care are, in fact, medically likely and should be reimbursed.
We hold these Medical Necessity Criteria to be self-evident: that all health conditions are created equal, that our interventions are coded using Current Procedural Terminology by CMS with certain unalienable Relative Value Units, and that among the multipliers that may be deployed to determine reimbursement including Location, Practice Expense, and the cost of medical malpractice insurance for their specialty. That, to secure reimbursements, Health Plans are instituted among Plan Sponsors, for the benefit of members, deriving their just and tax-exempt status from the ERISA act of 1974, with it’s fiduciary duty provisions--That whenever any Design of Health Plan becomes destructive of these ends, it is the Right of the Plan Members to alter or to abolish it, and to institute new Plans with associated benefits in keeping with rules and regulations, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Health and Happiness, at the lowest cost.
Prudence, indeed, will dictate that Health Plans long established should not be changed for light and transient problems with the coverage or the network; and accordingly, all experience hath shown, that mankind is more disposed to suffer, while evils—like prior authorization, coverage limits, pre-existing condition exclusions, and PBM clawbacks— are sufferable, than to right themselves by abolishing the Health Plans to which they are accustomed. People stick with jobs for even lackluster coverage, verily.
But when a long train of abuses and usurpations, pursuing invariably the same Denials and Coverage Limits, evinces a plan designed to reduce them to poor health, under absolute Despotism, it is their right, it is their duty, to throw off such Plan Administrators, and to provide new Plan Design and Benefits for their health and that of their dependents.
Such has been the patient sufferance of these Members; and such is now the necessity which constrains them to alter their former Systems of Health Plan Design. The history of the present King of Big Health1 is a history of repeated injuries and usurpations. These, in turn, may be acquired by UnitedHealth Group. All plan members have standing to appeal in direct objection the establishment of an absolute Tyranny over these Health Benefits. To prove this, let Facts be submitted to a insufficiently covered world:
He has refused his Assent to Coverage of the most wholesome and necessary care for the public health.
He has forbidden his Plans to authorize services of immediate and pressing importance, unless suspended in their operation till his Prior Authorization should be obtained; and when so suspended, he has utterly neglected to authorize to them, oft with many minutes on hold. Also, calls have been dropped at times inopportune and frustrating to the plan members.
He has refused to update CPT Code sets on an annual basis to account for all the medical services that exist, accoring the AMA. This disallows the accommodation of a large swath of treatments for the people unless those people would relinquish the right of coverage for breakthrough treatments described by new CPT codes, a right inestimable to them and formidable to penny-pinching health plans making billions upon billions only.
He has called together physician practices at rates unusual, uncomfortable, and distant from the expected remuneration of their services for the sole purpose of fatiguing them into compliance with his measures.
He has dissolved repeatedly contracts with physicians and their groups, for opposing with manly firmness his invasions on the rates they should be reimbursed for medical care.
He has refused for a long time, after such dissolutions, to cause others to be paneled, whereby the professional societies, incapable of setting reimbursement rates, have returned to the physicians little for their membership dues. The physicians remaining in the network, in the meantime, are exposed to all the dangers of invasion from patients with coverage policies inadequate, in that they don’t pay for the services the physicians deem medically necessary. These services too, are not included on the rate cards.
He has endeavored to prevent screening for the members of the health plans; for that purpose, he obstructed the guidance of the US Joint Protective Services Task Force regarding screening and refused to pay for such screenings as to benefit populations in the burden of preventable disease. Instead, these services are often reclassified as Evaluation and Management of disease, not screenings, as the law allows. This leads to irksome copayments when, under the accountable care act, there should be none.
He has obstructed the Administration of Benefits, by refusing to Authorize Breakthough Treatments for established plan members.
He has made Physicians dependent on his Contracted Rates alone, for the tenure of their professional lives, and the amount and payment of their salaries, as many are now subsumed into Optum Health Subsidiaries, or otherwise vertically integrated.
He has erected a multitude of New Offices, and sent hither swarms of Medical Directors to harass our practicing physicians and eat their hearts by forcing step therapy upon them, in contravention of law and appropriate standards of care.
He has kept among us, in times of plenty, ever-increasing deductibles, and whatever the hell coinsurance is. Who, among the members, has more than one insurance plan from their employer?
He has affected to render the Administrators independent of and superior to the Practicing Physicians in power.
He has combined with others to subject us to criteria for coverage foreign to our professional judgment, and unacknowledged by our Generally Accepted Standards; giving his Assent to their Acts of pretended medical necessity:
For Quartering large bodies of Purely Administrative Staff among us, and scheduling these administrative phone calls at times inopportune and inconvenient. Even on Saturday at 10 PM for Heaven’s sake. Is that any time to inform a physician of a prior authorization denial? True Story.
For protecting those medical directors, by bullish*t rules, from punishment for any Murders which they should commit while denying medically necessary care, as if they were not using medical judgment and rending medical decisions as MEDICAL DIRECTORS. It says medical in the name. It is the practice of medicine!
For cutting off our access to drugs at fair prices with all parts of the world, with rebates unsustainable and tiers non-preferred.
For imposing copays and coinsurance on us without our Consent.
For depriving us, in many cases, of the benefits of appeals to independent medical review panels.
For transporting us beyond our state medical boards to be tried for pretended offenses and dropped from panels abruptly and without appropriate warning.
For abolishing the free System of Medical Care as practiced in all other nations in the world, establishing therein an Arbitrary Plan Document, and enlarging its Rules and Limitations to render it at once an example and fit instrument for introducing the same denial of coverage and thus care across plans, but more so unto those covered, despite great vulnerability, by Medicaid plans
For taking away our Primary Care Doctors, abolishing our most valuable connections to said personal physicians, and altering fundamentally the physician-patient relationship.
For suspending our own medical standards, set by professional societies and the committees therein, and declaring themselves invested with power to regulate payment for us in all cases whatsoever, as if that wasn’t regulating care itself.
He has abdicated Mental Health Parity, by declaring us out of network, and waging War against us by having absurdly low reimbursement for Mental Health and Substance Use Disorder Services, in networks at the same time, insufficient, and not in keeping with Medical/Surgical rates of recompense.
He has plundered our seas, ravaged our Coasts, burnt our towns, and destroyed the lives of our people. This is somewhat surprising, but Big Health is also pretty cutthroat when delivering on shareholder value.
He is at this time transporting large Armies of foreign medical graduates as Medical Directors to compleat the works of death, desolation and denial, already begun with circumstances of Cruelty & perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized physicians. Many have suffered board complaints before they take these “denial as a service jobs,” too!
He has constrained our fellow physicians taken in Captive acquired practice groups the compete against their colleagues in narrow networks, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.
He has excited pharmacy benefit managers among us, and has endeavored to bring on vertically integrated mail order pharmacies, to which physicians must prescribe, no matter the lack of competent staff,
In every stage of these Oppressions We have Petitioned for First Level Appeal in the most humble terms: Our repeated requests for authorization have been answered only by repeated denial. An Executive whose character is thus marked by every act which may define a Tyrant, is unfit to be the Plan Administrator for members to whom a fiduciary duty is due.
Nor have We been wanting in attentions to our Non-physician colleagues. We have warned them from time to time of attempts by their plan to extend an unwarrantable restriction in benefits or hoops through which they, too, must jump prior to reimbursement. We have reminded them of the circumstances of our contracts and Administrative burden. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and fiscal viability of their industry—be it either pharma or med device! They too have been deaf to the voice of parity and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our disputes and appeals, and hold them, as we hold the rest of mankind, Enemies in Appeal, and in Approval, valued colleagues.
We, therefore, the Representatives of the united Physicians in interventional brain medicine, Assembled, appealing to the Supreme Judge of the world for the reimbursement of our interventions, do, in the Name, and by Authority of the good Center for Medicare and Medicaid Services, solemnly publish and declare, That these CPT Codes describing TMS treatment out to not be limited to once per day, it is ought that the medically unlikely edit that so limits them be totally dissolved; and that as Free and Independent Clinics, have full Power —up to 100% of machine power if necessary—to treat MDD, or OCD, and to accelerate that treatment, to contract payers, establish claims submission, and to do all other Acts and Things which Independent Practices may of right do. And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor, secure in the knowledge that more that one treatment per day is medically necessary, in this, our Second Level Appeal.
I assume this is Sir Andrew Witty, who is From the UK it turns out, but I don’t know for sure.