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Deferred Investment [An Incentive to Access]
By D. Kellus Pruitt; DDS
On Friday, the editor of the Chicago Dental Society’s [CDS] blog “Open Wide” posted a progressive, brief article titled, “State of Illinois offers incentive for dentists to treat Medicaid patients” (no byline).
http://chicagodentalsociety.blogspot.com/2009/12/state-of-illinois-offers-incentive-for.html
CDS says that last week, Governor Pat Quinn signed a law which allows Illinois dentists who treat Medicaid patients to accept payment deposited into a tax deferred investment portfolio instead of the traditional delayed, unpredictable payments that offer no tax advantages – only headaches.
Illinois Governor Quinn is a vast improvement over his predecessor. What was his name? He’s gone on to become a TV personality …. Oh yeah. Blagojevich!
I don’t know about you, but for me, Quinn’s incentive to access could offer not only more relief for those who cannot afford dental care in Texas, but it could also be a more or less painless way for dentists to fund IRAs – rather than having to do it at the last minute like I’ll do in a few months – just like every year. Instead of having an IRA hanging over my head, all I would have to do is donate my skills to help a few more people every now and then. That’s noble, charitable duty, friends – even with the Quinn incentive.
I especially respect current Medicaid dentists who work for nothing at all on the more profitable days.
To HHS Secretary Kathleen Sebelius
Pay attention. You only think you run the show.
The nations’ dentists you need aren’t being paid what they deserve, yet they put up with expensive and threatening CMS bureaucracy and struggle on – simply because they wish to ease suffering everyone else chooses to ignore.
Medicare dentists are American heroes to be sure. But let me warn you, Ms. Sebelius, they will turn on you hard and cold if you try to push them around. It’s time that you welcome real dentists to the bargaining table instead of ambitious ADA-approved stakeholders. You need us more than we need you, Ms. Sebelius. Forget the ADA. That is a foundation on which we can build … or not.
And this is for my stunned dentist colleagues in Texas who cross the street to ignore grandiose special bastards like me. Most of you detest the messy stuff I drag around, but nevertheless can’t stop watching from a safe distance. Rather than get your own hands messy, most of you simply pay the TDA to quietly and ineffectively hide or delay huge approaching problems. So what’s the trade-off? To remain “In the Loop,” you must obediently take up your differences with leadership in the approved, professional manner through designated ADA representatives. And. that’s so cute.
Now that you read about Quinn’s incentive, don’t you also hope that a TDA committee has already approved a draft of a deferred investment proposal to be offered to state lawmakers as soon as possible? After all, similar plans are already being tried in not only Illinois, but in four other states as well: Louisiana, Florida, Mississippi and Arkansas.
Hope as we may, nimrods, I fear those in Austin who should be paying attention to legislative opportunities such as this only heard about Quinn’s incentive to access law a minute or so ago at best.
Of Face Book Accounts
Both the TDA and the ADA desperately need functional Facebook accounts like Chicago Dental Society’s. By the way, it is the CDS which will be hosting their annual mid-winter dental conference in Chicago – reliably a tremendous meeting. This year it is Thursday-Saturday, Feb. 25-27, 2010 in the McCormick Place West Building.
The TDA’s Facebook Wall is pristine white and graffiti-ready, and the spray paint is free to any artist who walks by. Not unexpectedly, it’s a mess. Nobody is joining, and whoever is in charge of managing the site is busy deleting unacceptable comments from a jerk who has no respect for anyone. (It’s not me). The TDA Facebook is in trouble, and it has been suggested that it should be shut down. It is indeed an embarrassment.
Assessment
Here’s something we’ll all laugh about later: The one dentist in Texas who could have sent the rogue artist on down the road (me), was kicked off for badmouthing BCBSTX and the NPI number as well as 13 other listed allegations, including posting pornography. I’ll let the TDA Director of Membership explain that and the other allegations if you are curious. I was not provided access to the evidence on which the sudden and uncontestable revocation of my TDA benefit was based. But there’s still hope because a friend of mine resented the way I was treated and complained to the TDA using the approved channels. That was 2 months ago. I wonder how well that one is progressing from the Austin City dump.
The ADA Facebook is no better. Over 1600 fans have piled up at the door waiting for the ADA’s grand opening, yet nothing is happening. What do you think is going on there?
If you’ve missed hearing from me for the last 2 weeks and have an inquisitive mind, I’ve been pursuing answers for such questions about ADA and TDA transparency on Twitter. They call me Proots.
Conclusion
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Filed under: Breaking News, Funding Basics, Health Insurance, Health Law & Policy, Pruitt's Platform | Tagged: ADA, BCBSTX, Blagojevich, Chicago Dental Society, CMS, Darrell Pruitt, DDS, dentists, IRAs, Kathleen Sebelius, Medicaid, NPI, Pat Quinn, Proots, TDA, Texas Dental Association, twitter |
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Keep it Simple
As a financial advisor, I find this an interesting idea; but also see several related problems; none of which are deal-breakers. For example, with the plethora of qualified plans out there [IRAs, Roth IRAs, 401Ks, Roth 401Ks, 403Bs, SEP and SIMPLE IRAs, Keogh plans, etc], a logistics nightmare is a certainty.
Moreover; what about launching similar plans for the rest of us; the allopaths, osteopaths, chiropractors, podiatrists, optometrists, etc. You sure don’t want to encourage anyone to become a jealous anti-dentite.
Seriously, forget all the paper work and accounting machinations; just pay medical providers more money. In Other Words: KISS [Keep it Simple Sebelius]
Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
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Thanks for your response, Dr. Marcinko. You make a very good point that I overlooked. “Keep it simple.”
Speaking of keeping it simple, the Texas Dental Association gave up on their Facebook idea, just like BCBSTX did months ago and for the same reason: No tolerance for transparency.
The unopened ADA Facebook keeps piling on the fans, though. It’s incredible out here.
Darrell Pruitt; DDS
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More on K. Sebelius,
Didn’t a cardiology society just sue HHS Secretary K. Sebelius for the payment cuts in Echo and nuclear stress test that are upcoming.
So, why didn’t primary care doctors do this a decade ago when their cognitive skills were undervalued year after year; by the AMA’s CPT® coders, and the health insurers?
Jake
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Kay Bailey Hutchison listens to D. Kellus Pruitt DDS
I posted this on Kay Bailey Hutchison’s Facebook fan page today. Let’s see what I can do for Texas’ gubernatorial race.
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Thanks for hearing me out, Kay Bailey Hutchison.
Increased access to dental care for the poor is badly needed in Texas. I am a dentist who wants to help, but by my choice, I refuse to volunteer for the arbitrary National Provider Identification number that is required by CMS for participation in Medicaid – not to mention the miserable reimbursement that doesn’t always cover the cost to provide treatment.
Thousands of Texas dentists must feel the same way I do, because a third of them also choose not to volunteer for NPI numbers.
What do you plan to do about this dilemma?
D. Kellus Pruitt; DDS
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So just how powerful are social networks?
It’s not your dad’s Internet any more.
I hope everyone recognizes by now that personally representing one’s own interests on the wide open Internet is much more effective than trusting non-profit, anonymous, secretive organizations with their own bureaucratic interests – including political parties.
I assure you that Kay Bailey Hutchison read my challenge on her campaign Facebook, and I am certain that it caught her attention more than most. For spending less than 15 minutes, I arguably accomplished incredible penetration into her campaign. How long would it have taken the TDA to politely ask for the favor of her attention if she is of course not too busy, please?
What if I decided to dominate Kay Bailey Hutchison’s Campaign Facebook, just like I did to Dr. Bicuspid, BCBSTX and the TDA? Is her campaign manager ready to handle a special bastard?
After two or three times, it doesn’t bother me too much to get kicked off of Facebooks, and it never turns out well for communications directors…. just sayin’.
D. Kellus Pruitt; DDS
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Take cover! HHS Czar rumored to have ‘fire in belly’
Yesterday, Jack Moore, writing for ExecutiveGov posted “Digital Health Records Czar: HHS Has ‘Fire in the Belly’ on Guidelines”
http://www.executivegov.com/2011/06/digital-health-records-czar-hhs-has-fire-in-the-belly-on-guidelines/
Will the Czar use HHS guidelines tied to dentists’ voluntary NPI numbers to interfere in patient relationships in the same way he already controls defenseless physicians in the nation? Who knows? If it wasn’t for me, there would be no national discussion of dentists’ permanent NPI numbers or EDRs. That’s a shameful fact, Doc. And you know it.
What’s more, if I were wrong about the unethical promotion of HIPAA-controlled EDRs as ADA policy, stakeholders would have long ago tripped over themselves to be the first to bring national attention to my embarrassingly naïve misconceptions. Think about this: What does it mean if nobody in the nation contests my ominous opinions of EHRs in dentistry?
So where is the American Dental Association? The principle reason dental care stakeholders’ self-serving rumor of “mandated EDRs” persists is because of the absence of leadership in my profession. Our silence got us into this mess, Doc. When are you going to speak up? (Trust me: The air is fine and it’s free).
As far as dentistry is concerned, HIPAA and HITECH have always been absurd. So perhaps it’s better for all Americans if we resist calling federal appointees “Czars.” Especially if like Farzad Mostashari, they have fire in their bellies for “guidelines.”
Moore writes “On the question of whether the administration’s push on EHRs was adding another regulatory burden, Mostashari said the Office of National Coordinator for health IT, which he heads, is focused on aligning its programs ‘minimize the burden, but also maximize the signal to providers.’”
Are you receiving the Czar’s signal yet, Doc? The federal employee threatens to “maximize the signal to providers,” including dentists. Why does Mostashari feel he has the power to talk to fellow Americans and small business owners with such disrespect?
Calling the head of the ONC a Czar simply rewards tyranny. Let’s stop doing that.
Mostashari adds: “What we are asking [dentists] to do is nothing less than put in place [$40,000] structures that provide higher quality, more efficiency for care at higher value. Everything we do has to be aligned with that goal.”
I’m interested in hearing Mostashari’s explanation how $40,000 EDRs will provide higher quality dental restorations more efficiently and at a higher value than possible using paper dental records. And if Evidence Based Dentistry discovers that what’s been done so far hasn’t aligned to worthy goals in dentistry, then what? Ignore a few more facts in order to preserve our professional, “one-voice” appearance? “Image is everything” – ADA/IDM slogan.
D. Kellus Pruitt DDS
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HHS is looking for partners who have the talent to heal people and don’t mind “sharing” HIPAA fines
When Farzad Mostashari MD, the national coordinator for health information technology at the Department of Health and Human Services was asked by Margaret Dick Tocknell how he intends to protect the privacy of patients, he said, “It has to be a shared responsibility, so we have to work with our partners.”
http://www.healthleadersmedia.com/page-1/PHY-275143/Q-and-A-Farzad-Mostashari-on-Meaningful-Use-Privacy
“Shared responsibility”? “Partners”? Who is he kidding?
“We’re working with doctors, hospitals and clinics all over the country to have them learn the best practices, to make sure they are meeting the HIPPA [sic] security standards, and to mitigate risks so they don’t put patient data in harm’s way. It’s simple things like making sure if there’s data on a laptop then the laptop is encrypted, so if stuff is stolen or lost you don’t have a breach of privacy.”
Encryption has been around a long, long time. Yet in the last year, the frequency of data breaches of patients’ unencrypted Protected Health Information (PHI) has increased 32% and cost the industry an estimated $6.5 billion. Compared to Dr. Mostashari’s battle against data breaches. Nancy Reagan’s “Just say no” campaign was a phenomenal success at stopping drug abuse in America.
Dr. Mostashari continues:
“There’s also the important partnerships. The Office of Civil Rights enforces those breaches and makes sure that if there is willful disregard on the part of a covered entity [partner] for protecting that information that enforcement takes place. There have been literally millions of dollars in fines levied against organizations [partners].
The new protections under the HITECH Act mean not only do [partners] have to pay higher fines but [doctors] literally have to alert the media and the patients if they have a significant breach of patient records.”
Since physicians have no choice but to adopt EHRs with an almost 100% chance of losing patients’ PHI within a year, sharing responsibilities with Mostashari and his friends in OCR is hardly a mutually beneficial partnership. It’s tyranny against US citizens. What’s more, the subjective nature of “willful disregard” reliably keeps HIPAA covered entities from complaining about the tyranny. Good thing I’m not a HIPAA covered entity. Otherwise nobody would be complaining at all.
D. Kellus Pruitt DDS
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Open Government
[Watch out – ADA – Obama Transparency finally arrived]
Remember long ago when Barack Obama promised a more open government?
In January 2009, Ed O’Keefe of the Washington Post posted “New Obama Orders on Transparency, FOIA Requests.”
http://voices.washingtonpost.com/federal-eye/2009/01/_in_a_move_that.html
O’Keefe writes: “In a move that pleased good government groups and some journalists, President Obama issued new orders today designed to improve the federal government’s openness and transparency. The first memo instructs all agencies and departments to ‘adopt a presumption in favor’ of Freedom of Information Act requests, while the second memo orders the director of the Office of Management and Budget to issue recommendations on making the federal government more transparent.”
A year later, I expressed my approval of Obama’s desire for transparency in an article that was picked up by the Medical Executive-Post as, “I Want Obama Transparency for the ADA.” It was popular.
I hadn’t read anything more about Obama Transparency until yesterday when HHS.gov posted, “HHS Open Government Plan.”
http://www.hhs.gov/open/plan/planv2/transparency.html
True to his word, Obama even allows public comments following the HHS press release. Compare that to the kindness of American Dental Association’s notorious “one voice” stoicism. Did our elected dental leaders fear membership before or after they were properly vetted?
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Dear HHS Secretary Kathleen Sebelius:
In your “HHS Open Government Plan” revealed yesterday, you promise, “Substantial progress has been made in many areas developed to support greater transparency and understanding about financial resource data.” Yet no HHS official, EHR vendor or even HIPAA consultant has ever offered an estimate of how much HIPAA compliance adds to the cost of dental visits – even as the epidemic level of data breaches prove that the Rule’s tedious, time-consuming requirements and million dollar fines are failing to protect patients from identity theft.
So why is the cost of the disappointing mandate still a national secret?
Officials of the American Dental Association are not only unresponsive to dentists’ concerns about HIPAA – even those of dues-paying members – but I learned firsthand that if a dentist persists in demanding answers from ADA leaders who promote the mandate, it can cost one’s membership for “failure to uphold the dignity and honor of the profession.”
Unlike elsewhere in the free world, dissent is vigorously silenced by ADA leaders in favor of an ill-advised, obsolete PR policy of “one-voice” that leaders enthusiastically adopted a few years ago during the annual meeting in Orlando, Florida. Predictably, one voice PR silliness forced even well-meaning, vetted ADA leaders to become irrelevant and even harmful to those they serve.
Nobody disputes the fact that even without the additional, non-productive costs of HIPAA, EHRs in dentistry are already more expensive than paper dental records – as well as more dangerous for both dentists and patients. Now that you know the truth, Secretary Sebelius, how much longer do you intend to allow vulnerable Americans to be deceived by shy healthcare stakeholders who, unlike providers, cannot be held directly accountable to patients?
My patients are depending on HHS to take accountability for the HIPAA blunder. Otherwise, nobody in dentistry – not even the ADA lobbyists HHS depends on for recommendations – can be trusted by dentists who pay their salaries.
Sincerely,
D. Kellus Pruitt DDS
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Epilogue
After I posted my letter to Sebelius, I was told, “Your comment has been received. We will review your comment and post it if it complies with our comment policy.” Wish me luck!
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Tyranny in US healthcare is costly
“Battle heats up over Healthcare.gov paper trail,” by Joseph Marks was posted yesterday on Nextgov.com.
http://www.nextgov.com/health/2013/12/battle-heats-over-healthcaregov-paper-trail/75500/
“On Wednesday, Issa accused Health and Human Services Secretary Kathleen Sebelius of criminal obstruction for directing HealthCare.gov contractors to pass any congressional document requests through the Centers for Medicare and Medicaid Services rather than providing them to the committee directly.”
As I learn to recognize HHS Secretary Kathleen Sebelius’ way of doing business with poorly-represented providers, it’s becoming obvious that similar command-and-control skills have been passed down to the nation’s unresponsive dental leaders as well.
D. Kellus Pruitt DDS
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HHS Secretary Kathleen Sebelius fell behind in her obligations
“Friday afternoon and HHS has added dozens of new updates/revisions to the breach tool [aka: Wall of Shame] – after adding dozens more during the week? Yikes. As before, some of them appear to be older incidents that had never been posted publicly while others are more recent.” – Dissent Doe, writing for PHIprivacy.net, January 8, 2014.
http://www.phiprivacy.net/ok-now-hhs-is-messing-with-me/
If you have been following my posts, you perhaps already know the reason for the recent surge in previously unreported data breach incidents. If you recall, in November, the Office of Inspector General (OIG) criticized the Department of Health and Human Services for being too soft on HIPAA-covered entities – failing to enforce compliance from healthcare providers who are already straining to adopt ill-fitting EHRs under the weight of time consuming non-productive regulatory requirements, as well as liabilities unheard of with paper health records. (See OIG report: “The Office for Civil Rights did not meet all Federal requirements in its oversight and enforcement of the Health Insurance Portability and Accountability Act Security Rule”).
Click to access 41105025.pdf
Is it possible that HHS Secretary Kathleen Sebelius is trapped? On one side, unhappy HIPAA-covered providers whom she needs to provide the healthcare the government promises, are on the verge of rebelling against the clumsy encroachment of opportunistic bureaucrats into healthcare. On the other side, it is perhaps Sebelius’ sympathy with over-regulated and increasingly threatened providers that has gotten her in trouble with the OIG for not carrying out her obligations under HIPAA/HITECH… including timely posting notices of data breaches involving 500 or more individuals on the Wall of Shame.
“As required by section 13402(e)(4) of the HITECH Act, the Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals. These breaches are now posted in a new, more accessible format that allows users to search and sort the posted breaches. Additionally, this new format includes brief summaries of the breach cases that OCR has investigated and closed, as well as the names of private practice providers who have reported breaches of unsecured protected health information to the Secretary.”
In the end, an embarrassed Sebelius sided with the government rather than providers, and is now playing catch up.
D. Kellus Pruitt DDS
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