The 2010 drama has been the most torturous of all, with the possibility of a huge cut postponed for two months and then, when it was down to the wire, postponed one more month. Now, as the end of the month approaches, Congress is still considering a proposal to postpone the cuts for six more months.
But even if Congress comes through, there are other reasons to opt out of Medicare. No physician or hospital needs to be reminded that Medicare pays much less than commercial insurance and that Medicare reimbursement for specialties such as orthopedics has fallen. Meanwhile, specialists who are less dependent on Medicare could conceivably walk away from it and survive.
Mayo Clinic Arizona stopped accepting Medicare patients on Jan. 1 at one of its primary-care sites, saying the program pays too little, and many smaller practices around the country have opted out, including Stephen B. Reznicek, MD, a urologist in Cadillac, Mich., who has considered turning away many first-time, non-emergency Medicare patients (see: “Michigan Urologist Feels Impact of Congress’ Inability to Pass Fee Fix“).
“Opting out of Medicare begins with a philosophic choice,” wrote Kentucky Neurosurgeon Timothy C. Kriss, MD, who has opted out, on the Web site of the Association of American Physicians & Surgeons. “Believers in a free market will find government regulation and bureaucracy stifling, while others may find it tolerable. You must ask yourself whether participation in the program is consistent with your values.
“Opting out of Medicare also involves an economic choice,” he added. “It will result in a loss of income — possibly temporary, possibly permanent. Your practice may ‘recover’ (fill in with better payors) or you may see fewer patients. It is important to consider that the lost work and lost income are not proportional. Medicare pays less and costs more per patient on average. More time off with less income may be a desirable choice for you.”
There are two gradations of opting out. The more common one is to change to “non-participating” status, which means Medicare will send a payment to the patient instead of the physician and the physician can bill up to 115 percent of a Medicare-approved amount. Then there is the more extreme form, which involves leaving Medicare altogether and asking Medicare patients to pay all charges out-of-pocket.
Both AMA and AAOS have outlined how to become a Medicare non-participant (see: “With Fee Cut Looming, AMA Shows How to Become Medicare Non-Participant” and AAOS’ “Medicare participation options for physicians” ).
Contact Leigh Page at leigh@beckersasc.com.
