No Surprises Act; Immune System and Vaccines

• New federal law effective January 1, 2022 (see link on Dr. Weyrich's multimedia web page for today's (January 11, 2022) show.
• Not all parts yet implemented by bureaucrats who still have to write rules to implement Congress' intent.
• Applies to all medical providers (hospitals, doctors, labs, etc) providing service to un-insured, out-of-network, or cash-pay patients. Does not apply to Medicare patients, who are covered by other rules.
• In general, all applicable providers must give all applicable patients a written "Good Faith Estimate" in advance of (non-emergency) services.
• If the actual billed amount is more than $400 over the good faith estimate, there is a dispute-resolution process, and a cap on the amount that can be billed.
• E.g. A patient schedules to have back surgery and gets a good faith estimate that out-of-pocket costs will be $10,000 dollars, and then gets a bill for $10,400 then the patient has to pay. If the patient gets a bill for 11,000 then dispute resolution will decide whether there are extenuating circumstances justifying the increased price, such as additional emergency services are required (the patient has a heart attack during surgery). In the absence of reasonably unanticipated extenuating circumstances, the patient cannot be forced to pay more than $10,400.
• Because Payson Health and Wellness Center (PHWC) and Dr. Weyrich do not accept insurance of any kind at present, going forward all patients will be given the required good faith estimate. However, rarely does an office visit to PHWC cost more than $400, so this new law generates more paperwork for Dr. Weyrich to prepare and patients to sign, but gives little actual legal protection.
• However, the new law does encourage doctors to give "high-ball" estimates, especially for office visits that are billed for time spent. E.g. how much time is required to do a review of findings for a series of X-rays? It depends on how extensive the findings are, how many questions the patient has, and how quick the patient is to understand.
• In the next segment of today's show, Dr. Weyrich will outline how he approaches spinal treatments of new patients, and in the spirit of full disclosure, will present current billing rates for procedures used in his office.

The following is an outline of the "gold standard" treatment plan for a new spine patient seen by Dr. Weyrich.

• It includes all steps that are reasonably anticipated for a complex patient.
• By mutual agreement in advance between the patient and Dr. Weyrich, some steps may be skipped if the patient signs a waiver and Dr. Weyrich agrees that skipping the steps is safe, even if possibly less effective).
• The No Surprises Act requires that Dr. Weyrich disclose in advance not only a cost estimate, but an itemized list of procedure codes and the billing cost of each procedure.
• The steps are as follows:
  • Initial free 15 minute consultation, which does not create a doctor-patient relationship.
  • Patient agrees to a paid visit, and Dr. Weyrich prepares a Good Faith Estimate (GFE) of what (in his opinion) must be done in order to make an adequate diagnosis and develop a safe and effective treatment plan. The steps involved may include some or all of the following, usually in this order:
    1. Review of patient's health history
    2. Physical exam
    3. Review of findings and determination of additional testing required (revised GFE if necessary)
    4. MyoVision testing
    5. Review of findings and determination of additional testing required (revised GFE if necessary)
    6. X-rays
    7. Review of findings and proposed treatment plan with Good Faith Estimate.
  • Epoch of treatment: usually 10 treatments are proposed consisting of some combination of the following different treatment modalities each day:
    1. Diathermy
    2. Intermittent traction
    3. Ultrasound
    4. Massage
    5. Far IR Sauna
    6. Acupuncture
    7. SCENAR
    8. Exercise
    9. Spinal manipulation (drop table and/or activator)
    10. Spinal distraction (McManus table)
  • Case review and proposed plan of further treatment (revised GFE)

• The bone marrow randomly produces pre-B cells that could collectively recognize an almost infinite variety of different proteins that are called antigens (a different antigen pattern for each different pre-B cell), by a process of random DNA mutations that make each pre-B cell uniquely different.
• The pre-B cells circulate in the blood and die if they encounter a "self" protein that they recognize as an antigen.
• The remaining pre-B cells are called naive B cells, and lurk in the body until they encounter a protein that triggers them.
• Since pre-B cells that were triggered by "self" proteins already died, the protein must be a "foreign" (non self) protein that is evidence that the body has been invaded by a virus, bacteria, yeast, parasite, or perhaps undigested food leaking into the blood.
• When the naïve B cells are triggered, they change into plasma cells and do two things: (1) replicate or make many copies of themselves, and (2) produce billions of small proteins called antibodies, that stick to the triggering antigen protein and cause the immune system to wake up and attack anything that has the antigen protein.
• This process of plasma cells replicating and making antibodies can take several days to weeks, but in the best case, the immune system is activated enough to take out the invading microorganism without creating too much collateral damage (e.g. cytokine storm and inflammation) to the body itself.
• After the invading microorganism have been cleared from the body, the plasma cells convert into "memory B-cells" that "sleep" and no longer make antibodies.
• But if the previously invading microorganism "re-invades" the body due to a new exposure, the memory B-cells very quickly "wake up" and mount a very fast, strong immune response that usually prevents the reinfection from causing much of problem (usually a subclinical reaction).
• The whole point of vaccination is to inject into the body "samples" of protein that come from the virus or other pathogen we want to be protected against, and that then causes memory B-cells to be produced that will recognize when we become infected by the pathogen, E.g. COVID-19.
• We can use various analogies to explain the above process:
  • When we expose naïve B-cells to viral vaccines, we are showing them what part of the virus "smells" or "tastes" like, and therefore "teaching" them to become memory B-cells that are "triggered" by antigens that have that "taste" or "smell." The immune system "learns" from example what it needs to react to.
  • The more different parts of the virus we expose the immune system to, the better it can learn to recognize the attack by that virus. By analogy, we would want to expose a tracking bloodhound to different parts of the suspect's clothes, e.g. their socks may smell different than their t-shirt, which smells different than their underwear.
• The difference between being naturally exposed to COVID-19 and recovering, versus being vaccinated, is that natural exposure presents the patient's immune system with many different viral proteins or antigens, whereas the current COVID-19 vaccines only expose the patient to part of one viral protein, the "spike" protein. For this reason, we can expect better immune response from people that have previously been naturally exposed to all parts of the COVID-19 virus than we can expect from people that have only been exposed to a sample of the spike protein by vaccination.

This edition of Doctor's Housecall aired live on KMOG radio FM103.3 and AM1420 in Payson, AZ between 5pm and 6pm MST (Arizona Time) on January 11, 2022. Dr. Weyrich offers a free 15 minute consultation at +1 (888) 391-0414 to discuss any comments or questions you might have about this broadcast (subject to schedule availability).