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    A call for physicians to denounce third parties once and for all


    If anyone came to my practice to perform a random quality check on the care I give to my patients or to interview my patients, I cannot imagine he or she would leave with much dissatisfaction from the data collected. However, the notices that came in the mail from Humana suggested otherwise.

    Second, as a pulmonary/sleep physician, most of my patients are referred to me by physicians who are already providing exceptional care to their patients in these areas. Why would Humana want me to interfere with other physicians’ work?

    I was perturbed and called their 800 number. I was greeted by a friendly gentleman. When I explained this situation to him, he understood that as a consulting doctor, I did not have to interfere in these areas and told me not to worry about it. Subsequently, I repeatedly asked him to remove this erroneous information from my record; however, he could not give me a satisfactory answer that this would happen.


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    As a pulmonary physician, I thought my job was to learn about ARDS, IPF, COPD, etc., which I have a passion for. Suddenly, such outside parties are now forcing me to learn terms like NCQA and HEDIS, which causes unnecessary turmoil. I would think that all of our fellow physicians are experiencing similar issues in their practices as well. A great question is: Why have we, as physicians, allowed all of this to happen?

    Eventually, my suspicion is that the creation of such erroneous data by insurance companies, if not corrected, can lead to the accumulation of negative information against us, causing harm to our reputation and penalties against our compensation. Or maybe this is a sadistic way for third parties to kick us out of their plans.

    A distant analogy would be the current situation happening with NFL. Just like I want to mind my own business being a doctor (and not being bothered by issues like HIPAA and HEDIS), most avid NFL fans also want to be left alone watching the game on a quiet Sunday. Suddenly, the one refuge where fans could go to vent their frustrations and de-stress is being hijacked by political agendas, causing great turmoil, and seizing enjoyment from fans’ Sunday afternoon.

    I have a strong feeling that when we receive these letters from regulatory agencies and insurance companies, the well-being of my patients is the last thing on their mind. I think they always have ulterior motives as their bottom line. Similarly, the idiots creating havoc in the NFL probably care the least about the fans and the true spirit of the game.


    I appeal to my fellow physicians, let us denounce with a single voice such practices by third parties. Let’s demand that we just want to be doctors with control of the field we practice in. To hell with HIPAA, ICD-10, CPT, NCQA and the rest. 

    Kumar Yogesh, MD
    Practicing physician at Dresden Family Clinic for 24 years. Owner of practice, self-employed physician, medical director.

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    • Anonymous
      Wow! Where does Dr. Kumar practice medicine? Doctor who do you think pays the bill of healthcare. The day patients pay for their entire care, that day you can demand all this. When third parties pay for a service that you provide that the direct consumer of those services does not pay, third parties will call the shots. Just see how costs and utilization have increased over the years.

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