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Pediatricians Don’t Need Identity Politics

A tipster recently sent us an email from the American Board of Pediatrics. Like so many other medical associations, the board – which oversees the physicians who care for our kids – is fully bought into the woke agenda.

The email involves “maintenance of certification” credit, which is required for pediatricians who want to maintain their license. In the email, the board urges pediatricians to claim credit for DEI-related education, in reference to the “Diversity, Equity, and Inclusion” ideology that’s central to woke identity politics.

The board makes this stunning claim:

“The ABP understands that racism and other forms of discrimination contribute to health inequities among children of color and other under-represented groups.”

American Board of Pediatrics

Translation: Pediatricians need to be re-educated to stop them from being racist. Yet the board offers no proof that pediatricians are racist, biased, or anything else.

More to the point, the board is pushing ideas grounded in “anti-racism,” which demands discrimination on the basis of race. In the context of medicine, that means offering different levels of access and standards of care to people of different skin colors.

That’s right: The American Board of Pediatrics is implicitly endorsing racial discrimination while claiming to oppose it. This is a direct threat to the health and well-being of American children – and parents and physicians alike should demand better.

Have you seen the woke agenda at your pediatrician or doctor’s office? If so, please let us know – anonymously and securely.

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Things Keep Getting Worse at This Indiana Medical School

The Indiana University School of Medicine is forcing educators to waste time on woke ideology instead of focusing on student instruction or real professional development. How do we know? An insider recently sent us proof. 

Earlier this year, an administrator in the Department of Medicine sent the following note to colleagues:

“The department strives to advance our core values of diversity, equity and inclusion.  We are requesting both our faculty leaders and staff leaders (Managers and above) within our Divisions/Service Lines to spend a minimum of 2 hours on DEI focused professional development throughout the 2022 calendar year.”

That’s right: Senior faculty and staff must spend at least two hours learning woke ideology every year. The clear implication is that they should spend even more time. Yet every hour they spend on “diversity, equity, and inclusion” is an hour they don’t spend developing their medical knowledge or ability to teach students. 

Then there are the specific courses that faculty can take. Among others, the list includes:

  • How to Engage Meaningfully in Allyship and Anti-Racism
  • Diversity, Inclusion and Belonging for All
  • Advocating for Change in Your Organization
  • Strategies to Foster Inclusive Language at Work

IUSM also requires “Unconscious Bias, Microaggressions, and Microresistance Training.” At no point does IUSM pretend this faculty indoctrination has anything to do with medicine, because it doesn’t. But it has everything to do with identity politics. 

This mandate will hurt faculty by forcing them to spend time on ideology instead of education, while also spreading that ideology to their peers. It will hurt the medical students these educators teach. And it will inevitably hurt patients, who expect medical schools to teach medicine, not woke malarky.

Are you a medical school professor, student, or trainee? Let us know if you see wokeness.

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This Medical School Wants a Wokeness Czar

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The University of Washington School of Medicine is hiring a wokeness czar. That’s the reality of a new job posting for an “Assistant Dean for Equity and Medical Student Engagement.” The position isn’t filled, but it’s already clear the school is devoting precious resources to political indoctrination instead of medical education.

The job description for this position reads like a woke playbook:

  • The Assistant Dean will “provide oversight to medical student affinity groups,” which are generally organized on the basis of race.
  • The person will prioritize the “recruitment and retention of underrepresented and disadvantaged students,” which typically requires lowering standards for admission. 
  • He or she will work with a variety of “Equity, Diversity and Inclusion committees,” which exist for the sole purpose of forcing woke ideas on faculty and students alike.

Most notably, candidates are expected to understand the “impacts of structural and institutional racism on medical student recruitment, well-being and equity.” Translation: They must be fully bought into the woke worldview that racism is everywhere and overt racial discrimination is the best solution.

It’s bad enough that the University of Washington Medical School created this inherently politicized position. But what makes it worse is how the school is spending its money, which includes tuition dollars as well as public funding. Students, families, and taxpayers pay for this medical school on the assumption that it will teach people to become the best physicians possible. Instead, this institution is ensuring students are brainwashed with woke ideology. 

Is your medical school embracing identity politics from the top down? If so, please let us know – anonymously and safely.

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A Med Student Just Sent Us This Amazing Note

We recently received this note from a medical student. We are keeping their identity anonymous per their request.

I am a medical student at what is widely regarded as an elite academic institution. I came to medical school in search of a broader understanding of scientific truth and a deeper understanding of how the world works. But the field of Medicine, through its inextricable connection to academia, is instead propagating and rationalizing sociopolitical ideologies through a pseudoscientific lens. It is now willing to supersede the Hippocratic Oath.

This fact has become increasingly apparent to me since I entered medical school. I was immediately bombarded with critical race theory talking points. Students are encouraged to go on an intellectual scavenger hunt for racism, with the aim of identifying racism as the core factor underpinning every medical and scientific discovery and practice. Professors facilitated critical theory exercises where students must consider their intersectional immutable characteristics, thus implicitly identifying themselves as inherently oppressed, or inherently an oppressor among different dimensions. I have also had to attend many propagandistic and self-flagellating lectures on unconscious bias, systemic racism, etc. 

Aside from critical race theory, the medical school has taken clear positions on many controversial political issues, supporting what many view to be directly injurious to others. This includes radical abortion policy, chemical castration of children, authoritarian COVID policy, and other ideas which make a mockery of the framework of evidence-based medicine and the system of medical ethics that lay the foundation for Western medicine. Many of these positions are made explicit through public statements and direct influence of public policy, while some positions are established through internal memos as well as curricular components. 

Medical school leaders have openly supported participating in local violent BLM riots (being careful to pretend that there was no violence, of course), and routinely send out false and inflammatory statements about explosive political issues. As you might expect, dissent, or even questioning, of any of these viewpoints immediately evokes rage from other students and consternation from professors. 

Equally concerning, the time spent discussing these topics detracts from the time needed to cover medical concepts. In my estimation, I have had to attend more lectures on pronouns and left-wing politics than on kidney diseases. At the current rate, I will have a better understanding of how men get pregnant than how women get pregnant. 

Not only is this ideological rip-current creating the current cataclysm of public distrust in medical and scientific institutions, but it also brews partisan malcontent and destroys good faith debate among students and faculty. Of central curiosity to me, why are medical students allowing this takeover? Surely, not all must agree with these propositions. In my experience, a large percentage of medical students disagree with at least one of these objectives. Many students find these ideas to be illogical, recognizing that a substantial amount of time is being wasted with political nonsense, and they also realize that speaking up amounts to academic suicide. 

More strikingly, however, is that most students fail to recognize the gravity that these issues have on a societal level. They are willfully ignorant of the potent social harms and collateral damage that will ensue en route to the fatally flawed utopian vision of wokeism, including a new age of racial discrimination and authoritarianism. 

Many others are willing to play along with these issues on a simplistic level, careful to avoid identifying the nuances that may get them in trouble. It is easier for students to simply not think too hard. After all, developing a deeper understanding of the history and tenants of gender theory in order to contest these positions will waste even more time. Most students, understandably, do not see that as a valuable use of time when there are real, complex diseases to study.  

Medical schools, and universities more broadly, rely on the assumption that students will tacitly accept these radical ideologies, or at the very least that students will not be motivated or capable of identifying the profound logical fallacies and factual errors present. It is unavoidable that students who disagree with woke ideologies will have to spend the time to better understand and defend positions in order to confront these institutions en masse, in a manner that is articulate, professional, and thorough.  

Do No Harm is doing precisely that. Dr. Goldfarb is setting an excellent model. It is my hope that medical students will engage with the ideas that Do No Harm advocates, so that we may present a formidable intellectual force against the dangerous aspirations of radical left-wing medical schools and healthcare institutions. 

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This Georgia Medical School Is Violating Civil Rights

The Emory University School of Medicine is violating students’ civil rights – specifically by discriminating on the basis of race. That’s the message of an official complaint that Do No Harm filed with the U.S. Department of Education’s Office of Civil Rights on July 8th. The school must be held accountable for this blatant injustice.

Our complaint centers on a “Diversity and Equity Scholarship Program” in the medical school’s Department of Urology. It is solely available to applicants who are “African American, Latinx, and/or Native American.” This is racial discrimination, plain and simple, which makes the scholarships illegal under federal law. 

The Civil Rights Act holds that “no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance,” which includes Emory University.

We are asking the Office of Civil Rights to “promptly investigate the allegations in this complaint, act swiftly to remedy unlawful policies and practices, and order appropriate relief.” Racial discrimination is unacceptable – in healthcare as much as everywhere else.

If you know of a discriminatory scholarship or policy at your medical school, please let us know.

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This Florida Medical School Only Wants Woke Students

Are you woke enough to attend Florida Atlantic University’s Schmidt College of Medicine? Students literally have to prove it when submitting their application. It shows that medical schools are increasingly interested in pushing political ideology – and less concerned with training physicians.

A tipster who’s concerned by identity politics at FAU pointed us to this offensive requirement, which can be found in the list of secondary questions that applicants must answer. To start, they must show they believe in “anti-racism” and “systemic racism”:

“As a community FAU Schmidt COM has made a commitment to be anti-racist and address systemic racism in education and healthcare. Institutionalized racism can be defined as “macro level systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups.” As a future medical student at FAU, how can you play an active role in addressing and dismantling systemic racism?”

This is an insult to students – and a danger to healthcare. “Anti-racism” is inherently divisive and leads to racial discrimination. The founder of anti-racism, Ibram X. Kendi, has made that clear by saying “the only remedy to past discrimination is present discrimination; the only remedy to present discrimination is future discrimination.”

It gets worse. The FAU College of Medicine also asks students this:

“One of the values of the FAU Schmidt College of Medicine is to provide the best medical care for all people. A major challenge for all physicians to provide the best medical care are Social Determinants of Health (SDOH). These can be defined as “conditions in the social, physical, and economic environment in which people are born, live, work, and age.” What will you as a future doctor do to address SDOH?”

Translation: Students need to prove their commitment to solving social problems like homelessness, poverty, and so on. That’s not what medical schools are designed to do, yet woke ideology demands that students be activists first and physicians second.

What’s happening at FAU’s College of Medicine is far from unique. Nationwide, medical students and faculty alike are increasingly expected to prove their woke bona fides. But is that really what Florida taxpayers who fund Florida Atlantic University really want? If not, lawmakers should act immediately.

Are you a medical student or professor who has been forced to pay homage to woke ideology? If so, please let us know.

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Biden Is Forcing Hospitals To Go Woke

Hospitals may soon have to prove their commitment to woke ideology. This deeply concerning reality is buried in a 639-page proposed regulation from the Biden administration that deserves more attention than it’s getting.

The upcoming mandate directs hospitals to make five “attestations” that fully align with woke demands. If hospitals don’t do what the federal government wants, it appears that their federal reimbursements may be cut.

The federal government is demanding that hospitals:

  1. Develop a “strategic plan for advancing health equity” – including laying out specific actions that hospitals will take when providing care to people of different racial and demographic groups.
  1. Collect “demographic and social determinant of health data” – which includes everything from patients’ race or ethnicity to their income and employment status.
  1. Identify “gaps” in care based on patients’ race or identity.
  1. Engage in “local, regional, or national” activities to advance “health equity.”
  1. Set “an organizational culture of equity,” with hospital leaders demonstrating “routine and thorough attention to equity.”

Every patient should be worried. By demanding that hospitals advance “health equity,” the Biden administration is laying the groundwork for different standards of care or access to care for people of different races. And by gaining access to so much data on patient demographics, the federal government is setting the stage for further policies that punish hospitals for not toeing the woke line.

The Biden administration’s proposed regulation has nothing to do with healthcare and everything to do with divisive ideology. Hospitals should provide the best care for patients, not promise to uphold the party line. 

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This Medical School Is Forcing Professors To Be Woke

Be woke, or else. 

That’s the message that Indiana University School of Medicine just sent to its faculty. On June 16th, the Faculty Steering Committee formally approved a mandate that all professors demonstrate their commitment to identity politics as a condition of employment or tenure. IUSM is officially putting ideology ahead of medical education.

Do No Harm’s chairman, Dr. Stan Goldfarb, previously sent a letter to IUSM regarding this dangerous policy. He took issue with the mandate’s requirement that faculty (1) declare their support for “diversity, equity, and inclusion,” and (2) demonstrate the actions they’ve taken in pursuit of this agenda. 

Dr. Goldfarb wrote:

“Forcing candidates to declare their support for DEI when so many of them undoubtedly oppose it would compel dishonesty. Forcing candidates to show a track record of involvement in DEI would compel participation in and allegiance to a belief system. All of this is deeply illiberal and violates IUSM’s own professed commitment to academic freedom.”

He concluded by saying: “If you proceed with these standards, the IU School of Medicine will suffer.” The school will now prove it. Faculty will be stifled from teaching and researching non-woke concepts, while medical students will learn more about identity politics and less about caring for patients.

The good news is that the fight isn’t over. Indiana’s elected leaders should consider stepping in. After all, they spent taxpayer dollars supporting the school, and they can stop it from violating professors’ rights and harming medical students’ education. Someone has to protect Indiana from this woke mandate.

Is your medical school forcing professors to embrace divisive and dangerous ideas? Please let us know.

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Boston Children’s Hospital Goes Woke

A children’s hospital should be concerned with one thing and one thing only: Helping children. But Boston Children’s Hospital, one of America’s top pediatric care providers, is obsessed with something else: Woke ideology, which has nothing to do with the health and well-being of kids.

The problems began in 2020, when BCH adopted a “declaration on equity, diversity, and inclusivity.” One of its key goals is to “comprehensively educat[e] employees on the impact of racism on child health, unconscious bias, [and] bystander-upstander awareness.” This language has subsequently affected much of what the hospital does.

We received a tip from a concerned citizen about BCH’s continued descent into radical ideology. The person sent us a series of emails sent by the hospital’s president and CEO. Lo and behold, they focus on things like federal gun control and “incidents [that] are rooted in hatred and racism.” The people at the top of the hospital are setting a tone of partisanship and identity politics, when the focus should be on improving care for children.

The hospital’s research is also being subjected to layers of woke review. Researchers studying “Diversity, Equity, and Inclusivity” – or as Boston Children’s calls it, EDI – must go through a special review to make sure EDI research is being “conducted using equitable research processes” among other things. The equity researchers, in other words, need to be audited according to woke standards.

The concerned citizen also sent us some recent communications from BCH’s CEO. Earlier this month, the CEO sent an email detailing everything the hospital is doing to advance equity – from creating an “Institute for Pediatric Health Equity and Inclusion” to establishing employee groups focused on race.

What’s more, hospital leadership often end their emails by saying: “Support Health Equity / End Racism.” The tone at the top couldn’t be more clear, and it sets a tone of politicization at every level.

It’s a sad day for healthcare when a prominent institution like Boston Children’s Hospital loses sight of its mission of helping the youngest and most vulnerable among us. It’s even sadder when that vision of helping children is replaced by the hateful and divisive ideology of anti-racism.

Are you concerned about a pediatric hospital or other prominent healthcare institution? If you’ve seen anything similar to what’s happening at Boston Children’s Hospital, please let us know.

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The AAO Puts an Eye on DEI

Another day, another medical association caves to woke ideology. A tipster recently sent us an email from the American Academy of Ophthalmology in which the association commits to making identity politics a core part of its operations. What this information has to do with ophthalmology – the treatment of eye disorders – is never discussed.

The AAO email starts by saying it wants to reflect diversity in all its operations. But there’s a problem: AAO members aren’t required to disclose their demographic information. No problem: The Association wants every member to provide details on their race, gender, and other characteristics. The list includes gender identity, sexual orientation, and pronouns. 

What will this information be used for? To start, preferential treatment. The AAO intends to select “leaders, presenters, programs, and award recipients” based on their identity, as opposed to their achievements or objective qualifications. 

The AAO will also developing different “programs and services” it provides to its members. You can bet these new offerings will be less professional development, more political ideology, as we’ve seen with plenty of other medical associations. 

The only positive note is that members aren’t compelled to submit their information, nor will it be publicly displayed. But it remains to be seen how long those carve-outs last. If anything is clear about the woke takeover of healthcare, it’s that activists won’t stop until they dictate how all of medicine looks and works – from the physicians who get hired to the patients who get treated.

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These Ohio Medical Schools Are Violating Civil Rights

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Multiple Ohio schools of medicine are violating students’ civil rights—specifically by discriminating on the basis of race. That’s the message of official complaints that Do No Harm filed with the U.S. Department of Education’s Office of Civil Rights on June 14th. These institutions must be held accountable for this blatant injustice.

The schools in question are: 

Combined, these medical schools offer five scholarships that are available to students of certain races and identities. This is racial discrimination, plain and simple, which makes the scholarships illegal under federal law.

The Civil Rights Act holds that “no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance,” which includes all four medical schools.

We are asking the Office of Civil Rights to “promptly investigate the allegations in [these] complaint[s], act swiftly to remedy unlawful policies and practices, and order appropriate relief.” Racial discrimination is unacceptable – in healthcare as much as everywhere else.

If you know of a discriminatory scholarship or policy at your medical school, please let us know.

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This Indiana Medical School Is Violating Civil Rights

The Indiana University School of Medicine is violating students’ civil rights—specifically by discriminating on the basis of race. That’s the message of an official complaint that Do No Harm filed with the U.S. Department of Education’s Office of Civil Rights on June 14th. The school must be held accountable for this wrongdoing.

Our complaint centers on an IUSM scholarship program that is solely available to applicants of certain races and identities. This is racial discrimination, plain and simple, which makes the scholarships illegal under federal law. 

The Civil Rights Act holds that “no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance,” which includes IUSM.

Do No Harm previously submitted a letter to the IU School of Medicine regarding its mandate that faculty prove how woke they are as a condition of employment.

We are asking the Office of Civil Rights to “promptly investigate the allegations in this complaint, act swiftly to remedy unlawful policies and practices, and order appropriate relief.” Racial discrimination is unacceptable – in healthcare as much as everywhere else.

If you know of a discriminatory scholarship or policy at your medical school, please let us know.

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Comment Submitted by Do No Harm

Re: Notice of Proposed Rulemaking; Docket Number CMS-1771-P: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-Qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation

Introduction

Do No Harm is a policy and advocacy organization committed to protecting the integrity of American healthcare. We represent a diverse group of physicians, healthcare professionals, medical students, patients, and policymakers united by a moral mission: Protect and promote the healthcare that improves the health and well-being of every individual patient. We oppose injecting political ideology into healthcare, which should always be apolitical and patient-focused. Do No Harm is dedicated to empowering patients, medical professionals, and a diversity of Americans to promote medical fairness and equal access to care.

Climate Change and Health Equity

Through this proposed rulemaking, CMS is seeking strategies and approaches for addressing climate change, which it says directly impacts the medical community. CMS asserts without evidence that climate change disproportionately harms “underserved populations.” (Underserved populations refers to: “racial and ethnic minority groups, indigenous people, members of religious minorities, people with disabilities, sexual and gender minorities, individuals with limited English proficiency, older adults, and rural populations.”) CMS asserts that “the healthcare sector should more fully explore how to effectively prepare for climate threats.” This new mission is both vague and all-encompassing. 

CMS has requested comments from the public regarding: (1) the likely impacts of climate change on patients, residents and consumers so that they can develop plans to mitigate those impacts; (2) the understanding of exceptional threats that climate-related emergencies cause to patients so they can better address those issues; and (3) taking action on reducing emissions and tracking progress in this regard. CMS has indicated such action could apply to hospitals, nursing homes, hospices, health home agencies, and other providers. However, climate change is not even tangentially related to treating specific patients for specific illnesses. The healthcare industry should focus on improving the health and well-being of patients, including serving each patient’s unique and individual needs. CMS should oppose any rulemaking that distracts from the basic mission of medical care and creates a barrier between medical professionals and their patients.

Under this new potential rule, healthcare entities will be asked and possibly compelled by CMS to divert their focus and resources from serving patients to tracking greenhouse emissions. Medical professionals are not trained or equipped for this type of activity, and it strains credulity to believe that shifting time and attention to this contentious issue will do anything to benefit patients. It is far more likely to harm patients and therefore has no place in healthcare.

Health Equity Approaches

Stratification Methods

In the build-up to this rulemaking process, CMS asserts without evidence that significant and persistent inequities in healthcare outcomes exist today for certain demographics. CMS asserts that the worst health outcomes are often associated with individuals that belong to a racial or ethnic minority group; are a member of a religious minority; live with a disability; are a member of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community; live in a rural area; or live near or below the poverty level. Through this proposed rulemaking, CMS hopes to attain an equitable society by “designing, implementing, and operationalizing policies and programs that support health for all the people served by our programs, eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved, and providing the care and support that our beneficiaries need to thrive.”

In order to address healthcare disparities, CMS intends to use measurement and stratification methods, which are defined as calculating measure results for specific groups or subpopulations of patients. In short, CMS wants to collect a wide-variety of personal data from patients to categorize individuals with heightened social risk or demographic characteristics with associations to poorer outcomes. They will be categorized according to their group identity, per the list above, instead of their individual characteristics and medical needs. Such stratification threatens the individualized treatment that healthcare is supposed to provide.

Additionally, CMS wants hospitals to report confidential patient information in an attempt to highlight potential gaps in care between groups of patients. Yet these “gaps in care” are not actually about care. Instead, CMS is seeking to identify information regarding racial, ethnic, income, geographic location, and sexual orientation. By labeling these characteristics as disparities, CMS could use this information to single out healthcare providers and take punitive action against them. 

CMS claims to prioritize measures that focus on access to care. However, it appears CMS is using “access to care” as an attempt to collect more non-health related data from patients. 

Additionally, CMS introduces the concept of “non-clinical drivers of health.” These include “social risk factors such as socioeconomic status, housing availability, and nutrition, as well as marked inequity in outcomes based on patient demographics such as race and ethnicity, being a member of a minority religious group, geographic location, sexual orientation and gender identity, religion, and disability status.” This self-reported data, which by CMS’s own admission complicates its ability to choose effective metrics to evaluate disparity, will be used as indicators for health inequity. This means CMS is creating a reporting system with acknowledged flaws. Such a flawed system should not be used as a basis for rulemaking or policies of any kind.

CMS is inappropriately seeking to restructure how the healthcare system approaches patient care. It asserts that “attributing differences in outcomes to race may inappropriately place the driver of poorer health outcomes on the patient, rather than on structural factors, such as racism in society and the healthcare system that drive the provision of lower quality care.” Rather than addressing individual symptoms and lifestyle choices to treat a patient, CMS sees health equity as an opportunity to address the supposed “racism in society and the healthcare system.” By hijacking the medical relationship between a healthcare provider and his or her patient to include “structural factors,” the well-being of the patient is no longer the primary focus. This is a dangerous precedent for CMS to set. Individual health should always be the main priority in the healthcare system.

Furthermore, CMS acknowledges that once reporting of healthcare disparities is complete, the presentation of results will not be objective. CMS offers four ways for stratified results to be presented: Statistical Differences; Rank Ordering and Percentiles; Threshold Approach; and Benchmarking. For example, when using the Threshold Approach, healthcare providers could be grouped based on their performance using defined metrics, such as fixed intervals of results of disparity measures, indicating different levels of performance. However, this method does not convey the degree of disparity between healthcare providers or the potential for improvement based on the performance of other healthcare providers. It also requires a determination of what is deemed “acceptable disparity” when developing categories. CMS could potentially create a healthcare provider ranking system based on the results of the nonmedical, social risk factors included in the stratification method—another unacceptable and inappropriate use of the healthcare system’s resources.

Taken together, CMS’s efforts at stratification come down to the creation of a confidential database of patient information that will distract healthcare providers from treating patients highest and most individualized level. 

The Hospital Readmissions Reduction Program

CMS seeks comment on (1) The benefit and potential risks, unintended consequences, and costs of incorporating hospital performance for beneficiaries with social risk factors in the Hospital Readmissions Reduction Program; (2) the approach of linking performance in caring for socially at-risk populations and payment reductions by calculating the reductions based on readmission outcomes for socially at-risk beneficiaries compared to other hospitals or compared to performance for other beneficiaries within the hospital; and (3) measures or indices of social risk, in addition to dual eligibility, that should be used to measure hospitals’ performance in achieving equity in the Hospital Readmissions Reduction Program. Once again, the proposed rulemaking threatens healthcare providers’ ability to treat and improve the health of individual patients.

The Hospital Readmissions Reduction Program is a Medicare value-based purchasing program that encourages hospitals to improve communication with patients and caregivers in discharge plans and thereby reduce readmissions. This program is designed to improve the quality of hospital care for all Americans. CMS now wants to use it to improve “health equity” and reduce healthcare disparities, despite there being no statutory authority for changing the program’s purpose and goals.

By pursuing this rulemaking, CMS will change the medical community’s focus from medical diagnosis and treatment to social issues like income, education, employment, and housing quality. However, these indicators remain unconnected from and unnecessary for treating the patient’s individual health needs. CMS should not be distracting healthcare providers from focusing on patients’ specific health concerns and treatment plans. 

Data Collections

CMS seeks public comment on how the reporting of diagnosis codes in categories Z55–Z65 may improve CMS’s ability to recognize severity of illness, complexity of illness, and/or utilization of resources in an effort to advance health equity for all. CMS wants to expand its data collection by requiring medical facilities to report to CMS additional diagnosis codes in the Social Determinants of Health (SDOH). CMS uses SDOH as an assessment for coverage decisions and for designing programs, benefits, and services, yet making decisions based on these factors has no proven correlation with improving patient health and may in fact undermine it.

Specifically, Codes Z55-Z65 include the following data: (Z55) Problems related to education and literacy; (Z56) Problems related to employment and unemployment; (Z57) Occupational exposure to risk factors; (Z59) Problems related to housing and economic circumstances; (Z60) Problems related to social environment; (Z62) Problems related to upbringing; (Z63) Other problems related to primary support group, including family circumstances; (Z64) Problems related to certain psychosocial circumstances; and (Z65) Problems related to other psychosocial circumstances.

The information in Z Codes is self-reported by the patient. According to CMS, “patient self-reported documentation may be used to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the medical record by either a clinician or provider.” Documentation of social information from social workers, community health workers, case managers, or nurses could be utilized if the documentation is included in the patient’s official medical record.

By expanding data collection to include such characteristics as housing and social environment, CMS could decide to increase Medicare coverage for individuals that fall into these categories. Additionally, CMS could rank and assess healthcare facilities based on their interactions with patients from certain demographic groups. This means CMS is attempting to identify certain demographics in its data collection efforts for non-healthcare purposes. By requiring medical facilities to report this data, CMS is once again diverting resources and time from patient care. CMS should not be spending money on an initiative that is meant to collect data on non-medical information.

Conclusion

CMS’ proposed rulemaking threatens medical excellence and the quality of care provided to patients. It injects controversial, politicized, and non-medical factors into federal healthcare decision-making, which will limit providers’ ability to serve patients’ unique needs and develop individualized treatment plans. CMS should focus on improving health outcomes for everyone, which this proposed rulemaking fails to do.

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New Senior Fellow Joins Do No Harm Team 

Benita Cotton-Orr has officially joined Do No Harm as of June 13, 2022. As a senior fellow, Cotton-Orr will help Do No Harm prevent the woke takeover of America’s health care system.

Cotton-Orr, who immigrated from South Africa in 1986, is a policy expert with a background in journalism. Her outspoken opposition to racially based and discriminatory policies is rooted in personal experience and the discrimination and inequities her family, friends and colleagues suffered under apartheid.

“Benita has a powerful voice to speak on behalf of patients who are tired of divisive ideologies creeping into the healthcare sector,” said Dr. Stanley Goldfarb, chairman of Do No Harm. “Her depth and breadth of experience in shaping public policies is a great addition to our team, and we look forward to her supporting Do No Harm’s mission.”

Cotton-Orr is a respected voice for principled, policy solutions who has moderated events and addressed civic and leadership groups across Georgia on current issues and free-market solutions. She has been a frequent contributor to newspapers and television and radio programs around the state and spent seven years providing free-market perspectives as a conservative commentator on a weekly Atlanta Radio Korea program.

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Proposed Federal Rule Would Enlist Hospitals In Woke Activism

Background

On April 18, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for inpatient and long-term hospitals that will force these medical providers to advance a divisive and potentially discriminatory agenda. This rule is a danger to the health of millions of Americans.

This rule is part of the Biden Administration’s campaign to impose “equity” goals on healthcare, based on the false narrative that healthcare suffers from “systemic racism.” CMS intends to force healthcare providers to gather and report information on patient race, ethnicity, income, geographic location, sexual orientation, and gender identity. This information will feed into vast patient databases that can be used to reward or punish healthcare providers, based on their fidelity to identity politics. 

The proposed rule would also establish a process in which hospitals screen and identify patients’ non-medical problems (i.e., housing, difficulty paying bills, transportation needs, etc.). This data will be reported to the federal government and could also be used to reward or punish providers.

CMS is also interested in the alleged impact of climate change on patients, residents, and consumers, and seeks greater understanding of threats posed by alleged climate-related emergencies. Like the administration’s “equity” agenda, the focus on climate change is a political intrusion into healthcare.

Health Equity 

Stratification Methods

  • CMS wants to collect a wide variety of personal data from patients in order to create more precise categorizations of patients along race, gender, and other demographic lines.
  • CMS wants hospitals to report confidential patient information to highlight potential gaps in care between groups of patients. By labeling these differences as disparities, CMS could use this information to reward or punish certain healthcare facilities.
  • The proposed rule would distract medical professionals from providing care to patients and instead saddle them with a new mandate focused on politicized and non-medical issues.

Data Collection

  • The Biden Administration wants to use a politicized tool known as the “Social Determinants of Health” (SDOH) for collecting information on racial demographics for each hospital.
  • This includes problems related to employment and unemployment, housing and economic circumstances, and social environment, among other non-medical factors.
  • CMS will use SDOH data to track the interaction of medical facilities with certain demographic groups. The goal is likely to use this information to influence funding, medical supplies, and possibly even the distribution of medicine and therapies.

Climate Change 

  • CMS states that climate change disproportionately harms “underserved populations,” such as minority groups, indigenous people, members of religious minorities, people with disabilities, sexual and gender minorities, etc. This is a non-medical assertion.
  • Under this rule, healthcare providers will have to shift resources away from patient health and start tracking greenhouse emissions, a task that medical professionals have no competence in. 

Comments on the proposed rule must be submitted by June 17, 2022.

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Dr. Stanley Goldfarb Responds To His Critics

This blog is authored by Do No Harm chairman, Dr. Stanley Goldfarb.

I recently tweeted about an article in the journal Academic Medicine. The article found that a group of minority residents (who are referred to as “underrepresented in medicine”) scored worse than a group of white residents on all dimensions of the assessment system used by the faculty at three academic medical centers. The authors entertained only three possible explanations for this finding: attending bias, a less hospitable training environment, or a racist assessment system. 

My tweet posed an obvious question: “could it be they were less good at being residents?” 

It’s a logical question. In the name of diversity, medical schools have lowered admission standards for years, to the point of abandoning standardized tests and changing candidate evaluation systems. This has led to a situation in which some minority students come to medical school with marginal academic records and then struggle when they enter  medical school. Moreover, assessments have become less rigorous, so identifying struggling students has become more difficult.

This raises the possibility that the assessments in the Academic Medicine journal are correct: While many minority students could be excelling, many others could be performing less well. It’s the obvious explanation and research should examine whether it’s the correct explanation, which it may not be. Yet the study authors did not allow for the possibility—even for the purpose of debunking it.

In the absence of any analysis to the contrary, my question points to a plausible reality. Yet instead of debating the merits of my argument or doing a deeper dive on the underlying research, I received an onslaught of criticism—including from medical leaders who should know better.

Dr. Michael Parmacek, the Chairman of the Department of Medicine at the Perelman School of Medicine (where I served as associate dean until 2019), wrote to the faculty and staff of the department. He was surely responding to the predictable and unremarkable anger on Twitter and presumably from some students, staff, or faculty at Penn. Yet instead of showing leadership or standing up for medical standards and academic freedom, he engaged in ad hominem attacks and called my words “racist.”

His statement was as unacademic as it was cowardly. He refused to engage with the question of why some students perform worse in evaluations. Nor did he attempt to substantiate his accusation that I made racist statements. Most disturbingly, he failed to reflect on whether his institution’s own admissions policies could degrade the quality of medical students and therefore the care that current and future patients receive from them. 

Instead, Dr. Parmacek simply denounced me and genuflected before his own constituents—the administrators and students determined to reorient medical education away from science and rigor and toward their own view of social justice. 

The practice of medicine demands that the practitioner first Do No Harm. By refusing to ask hard questions, let alone obvious questions such as the one I posed, the Perelman School of Medicine (and most medical institutions, for that matter) are threatening patient well-being and the excellence of the entire medical system. 

What if lower standards in medical school admissions are producing quantifiable decreases in the quality of the residents those schools produce—as the study seems to suggest? What if these admissions policies are actually hurting minority students, and for the many who succeed, casting a cloud over their success? And is it really better to ignore these questions in service of “social justice”? 

Surely not. The patients we serve deserve better. The physicians we’re training deserve better. It is incumbent on medical schools and researchers to address these questions honestly and fairly. Burying their heads in the sand and attacking those who refuse to do so as racist is appeasement—and a total abandonment of the critical thinking that scientific and medical progress depend on.

As a long-time medical educator and practitioner, I will not be deterred by slanders and acts of intimidation. I will continue to ask uncomfortable questions in pursuit of the truth and improved outcomes for patients, not least because I’ve heard from countless other medical professionals who are deeply concerned yet afraid to speak out. The pursuit of truth must be the lodestar of medical education—not the feelings, political agendas, and employment prospects of health care providers.

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Must Read: A Letter From A Medical School Faculty Member

Do No Harm received this letter from a clinical faculty member at University of Washington School of Medicine. We are keeping the person’s identity secret for their professional protection.

May 31, 2022

To Do No Harm,

I am a physician on the clinical faculty of our local medical school. I have been quite concerned about recent developments at the school, which recently opened an “Office of Healthcare Equity.” At least some of it appears to be agenda driven, hijacking and distracting the focus of the school from evidence-based medicine into the social realm. 

Recently, following the tragic shooting in Buffalo by a racist man who targeted African Americans, the following was sent out by the Office:

Please join the Office of Healthcare Equity in affinity groups for our BIPOC colleagues and a caucus for our white colleagues who want to stand in solidarity with BIPOC colleagues… These sessions will offer a safe space, respite and community to process and support one another following the racially motivated shooting in Buffalo, New York… We will join as one group at the start and then meet in breakout rooms based on identity (Black, People of Color and White). 

In response to this invitation, I sent this anonymous note to them: 

Greetings,

I am a faculty member at UW Medicine. I am writing from an anonymous account because I do not trust my professional safety were I to disclose my name. 

This is prompted by the upcoming affinity groups that the school is organizing and promoting. 

I will state unequivocally that the shooting in Buffalo was horrific and driven by unacceptable beliefs that we as a society must confront and deal with. 

But I am not supportive of this selective horror being a focus of organized efforts on the part of the school. Staying in our lane of medical education is demanding enough. There are innumerable injustices and causes that warrant attention by society, but is the school the right place and if so, why stop there? 

Furthermore I believe that organizing groups on the basis of personal identity is racist, divisive and not appropriate for any tax supported institution. 

Much more can be said about the Office of Healthcare Equity, as I have real concerns about an outsized influence and agenda setting that may not suit the school or society in the short and long-term, but which few are willing to call out. 

I found myself wondering when you offered up an opinion and action on this tragedy, if you will consider similar interventions the next time a group of people are murdered based upon hatred of their group. This could include but sadly is not confined to:

– Antisemitic attacks on synagogues or individual Jews.

– Attacks on Asian identified individuals based upon their origins.

– Attacks on gays and lesbians.

– Misogynistic attacks on women.

– Perhaps expanded attention to genocides and religious and gender persecution in China, the Middle East, Africa and elsewhere.

I do not expect a response to this as I am sure this sort of message does not sit well with some at the school, though I suspect that I am not alone. 

Thank you for your attention and careful consideration. 

– A faculty member

I respect my profession and have been in practice for decades. The above is one of several grievances I have experienced of late at my school that cause great concern. I am grateful that Do No Harm has been organized, to among other things, call out racial divisiveness and social agendas contaminating our valuable profession.

– A Concerned Physician

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What Counts for “Education” At Stanford’s Medical School

Another day, another medical school pushing woke ideas on physicians. This time it’s Stanford University School of Medicine, which has a course focused on “unconscious bias in medicine.” As with similar efforts nationwide, this course is consciously steeped in ideological bias.

The course, which is specifically designed for current physicians looking to fulfill “Continuing Medical Education” requirements, immediately admits that it’s a “seemingly non-science topic.” Sure enough, it lays out goals that have nothing to do with science or medicine. The list includes getting physicians to acknowledge “the effects of unconscious bias in everyday interactions” and “identify where personal unconscious biases may reside across gender, race/ethnicity, and/or cultural attributes.”

Once they sign up for the course, physicians take a test that shows their “baseline” bias. They are then bombarded with ideology to convince them of their bias and help them overcome it. Far from helping physicians view people equally, the course pushes physicians to focus primarily on their patients’ racial, cultural, or gender identity, which is itself discrimination. The course also involves Harvard University’s discredited Implicit Association Test, which falsely claims to show someone’s bias.

At the end of the course, physicians must take another test and get at least 75% of questions right in order to pass. One question focuses on using something called the “camera technique” to overcome bias toward a transgender patient. Overall, the questions reinforce the perception that physicians are biased – a dangerous assertion that insults physicians and injures patient trust in healthcare.

Such courses are rapidly becoming mandatory. States like Michigan and Massachusetts have already implemented a requirement that physicians take regular courses on unconscious bias, and to fulfill it, they’ll turn to courses like Stanford’s. The deeper this so-called “education” seeps into healthcare, the more damage it will do.