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We're Leaving Medicare to Save Our Practice
We stopped accepting new Medicare patients this past January, a gut-wrenching but necessary step. We plan to stop participating in Medicare by the end of this year or the next, and we're likely to opt out of Medicare altogether.
Health Reform and Russian Roulette
This year has been even worse. Congress allowed the disastrous 21.3 percent pay cut to go into effect June 1, finally rescinding it a few weeks later and giving us a 2.2 percent increase -- but only until Nov. 30. Have you noticed that Nov. 30 is after the next election? How convenient for Congress!
If Congress lets the 21.3 percent pay cut return after Nov. 30, it will be the death knell for many practices. The typical primary care practice has 60 percent overhead, so there's 40 cents on the dollar to take home at the end of the day. The 21.3 percent pay cut would take away about 20 cents of those 40 cents. I don't know any doctor who can absorb a 50 percent decrease in income and not face some unanswerable repercussions.
Congress might instead continue the 2.2 percent increase after Nov. 30, but Medicare pay still would be inadequate.
Some help will come from the new health reform law, which provides a 10 percent primary care bonus beginning in 2011. Unfortunately, the bonus is only for those who meet certain requirements, only for certain types of claims and only for five years. Furthermore, a 10 percent bonus on top of the possible 21.3 percent pay cut would still equal a disaster, just not of such epic proportions.
The bottom line is that legislators need to step up and push payment reform through, but I'm not optimistic, given their track record.
Unilateral Changes, Unending Hassles
Here's a perfect example. A few years ago, we decided to offer stress tests to detect heart disease. Since we didn't have all the equipment, we and several other doctors rented space in an existing facility and went there once a week to perform the tests.
But Medicare changed the rules so that this violated the Stark laws. Instead, the facility had to buy mobile equipment, and the technicians had to lug it to our office once a week.
Last January, Medicare changed its rules again. Since the technicians weren't our full-time employees, Medicare decreed that their costs had to be passed through with no profit to us -- and we couldn't charge for office space or other costs. We would lose money on every single test. Therefore, the most profitable thing we did with our treadmill in recent months was to sell it. Unfortunately, all of the technicians were out of a job.
Medicare didn't change the rules because of quality concerns. They did it under the guise of eliminating fraud and waste, but I think they changed the rules because they were spending too much money on stress tests. In a discreet form of rationing, we have lost our best way to detect the leading cause of death in the nation. Our practice won't continue in a system that mandates what we can and can't do in the exam room for strictly financial reasons.
There are many other frustrating aspects of Medicare involvement, ranging from the silly bullet points we need in our charts to keep from being audited to the numerous pages of regulations (276-page PDF; About PDFs) we must wade through to learn how to qualify for "meaningful use" incentives. I can't wait to be done with it all!
Beyond Leaving Medicare
However, since all insurers eventually follow Medicare, the problems with Medicare will still haunt us. The only sure way to get out of Medicare's shadow is to stop relying on third-party payers altogether. I frankly think that might be necessary for family medicine to survive.
Millions of formerly uninsured people will need access to family physicians as the provisions of the health reform law go into effect. What will America do if most of our practices go broke and close in the face of this need? I hope other family physicians will consider getting out from under Medicare as we are. If our practice in Florida can do it and survive, maybe your practice can, too.
Lee Gross, M.D., is a practicing family physician in North Port, Fla.
Why I'll Keep Accepting Medicare Patients
Congress Approves Medicare Payment Patch, Provides 2.2 Percent Update