Dear Margaret,
I received your letter to me that was in the December issue of JNCCN.1 It was so beautifully written that I felt you deserved a reply, even though I will be unable to give you what you wanted for Christmas (except for that sparkly bracelet and the red Jimmy Choo shoes—please enjoy!). I apologize that I could not respond to your letter sooner, but it takes forever to document the December trip in the ESR (electronic Santa record). Rudolph appreciated your concern about his nose; cold does not appear to exacerbate the Rudolph Phenomenon.
You asked for the Affordable Care Act to get affordable again and for there to be reimbursement reform. I share your concerns. None of our elves were eligible for subsidies, and the SMO (Santa Maintenance Organization) refused to pay our local physician enough to cover office expenses. Our physician was also concerned about mal-elf practice; she opted for early retirement. So far, no matter how well we have tried to gift-wrap it, we have not been able to find any new physicians willing to freeze their “antlers” off up here while dealing with the red tape involved in running a solo practice.
In regard to cancer drugs, there is not currently enough of the Christmas spirit going around to make them affordable. It is my understanding that many oncology patients have been receiving treatment with the “SCREWED” regimen. Dr. Hagop Kantarjian has tried to be a good boy and help people stuck with the cost of this type of regimen; he deserves our thanks for speaking up in this regard. Some insurance companies have chosen to offer coverage limited to the “SCROOGE” regimen.
You expressed less than whole-hearted enthusiasm for MACRA, CHIP, HIPAA, and other bureaucratic regimens. How do you expect the bureaucrats to keep their jobs and their health insurance if they don't keep coming up with these things? Some of those who make the rules really do think they are helping the situation. They don't always realize that there can be serious side effects from what they prescribe. Theoretically, the ideas are great and we live in the best of all possible worlds—unless you actually have to work in the trenches implementing certain aspects of these not-so-silent nightmares.
I would like to pass along your concerns to the bureaucracy; however, they do not believe in Santa Claus. This leaves you with 3 options. First, you can stop caring about and trying to help your patients, spend your days and nights documenting esoteric things in EMR, and accept a diminishing paycheck. Second, you can join the bureaucracy. As part of the bureaucracy, you can make up any rules that sound good. If you prefer, you can even make them up now and read them later. Just remember to exempt yourself from them. Or third, you can continue your efforts, as demonstrated by your letter in JNCCN, to try to make a difference and improve things.
Your letter helped reassure me that there are concerned physicians who are trying to improve the system in order to help their patients. Thank you! Best wishes for a happy and healthy 2017!
Sincerely,
Santa
Ken Goldstein, MD
Jacksonville, FL
Call for Correspondence
JNCCN is committed to providing a forum to enhance collaboration between academic medicine and the community physician. We welcome comments about the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), articles published in the journal, or any other topic relating to cancer prevention, detection, treatment, supportive care, or survivorship.
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