For a number of years deciding whether or not to participate with Medicare has not been difficult. Most Urologists, and in fact most physicians participate with Medicare.
At the same time, Medicare reimbursements have been flat or have decreased. We once again approach a new year with the potential of a decrease in the conversion factor due to the SGR formula. At the same time, the healthcare debate has thrown everything up in the air while at present holding the conversion factor and SGR hostage. How much more can you take?
From the governments prospective Medicare works just fine for seniors. Most doctors participate and most patients receive the care they need. At the same time, the US has historical debts, and is facing continued increases in healthcare costs and an increase in those reaching Medicare age. Therefore the government can conclude, physicians make too much money, the incentives for physicians are incorrect and causing more expensive treatment to be ordered, and we should cut payments to physicians or significantly change the way payments to physicians are made.
The physician lobbying efforts, through cash, are not what they could be and will likely never reach the amount of spending that other groups in healthcare such as Hospitals, Insurance Companies, and Pharmaceuticals routinely spend. What is left to truly place the government on notice that Physicians should be paid more fairly? Taking action.
Consider as well, that retire people are one of the largest and most vocal voting blocks in the country. Without providing an in depth analysis or opinion piece on the current government, it seems that the goal of most elected officials is to get elected or re-elected. Therefore, in lieu of money, the physician community will have to activate this block of voters.
Unfortunately, motivation to prevent a potential problem is not nearly as concrete as the motivation generated to solve an existing problem. I would propose then, that the logical choice of physicians to bring about change is to make healthcare payments problematic to seniors.
Opting out of Medicare is not a viable option for most physicians as this move requires that the physician is out of Medicare for two years. Further services provided by a physician that has opted out of Medicare may not be not reimbursed to the patient.
NOT TO PAR
One option is to elect to become a non-participating provider. You can elect to become non-participating at the end of each year and if you choose, change your status the next year. Services provided by a non-participating provider are covered but are paid to the patient at a reduced rate. The non-par provider is capped by what s/he can charge (approximately 109% of then current Medicare rates) and is responsible for collecting his/her fees from the patient.
Experience has shown that although this is a difficult change, it can be done. You will need to notify your patients as to when and why you are making this change. You will have to get better at managing payment expectations and change the culture of your practice to a more consumer-oriented model. If you can manage the basics, the results will be more far reaching, and in the long run create a stronger practice. Further, if joined by enough of your peers, it will drive change.
PAR
Of course, going non-par is difficult if not impossible in many markets. Can you still send a message while participating in Medicare?
As I travel around the country and speak with groups in this regard, I have been presented with multiple solutions to the dilemma of remaining par but still sending a message to Washington.
One is to simply not take new Medicare patients in the practice. Most practices are busy enough to select the patients they want to allow into their practices, and are choosing not to accept new Medicare. If the issue is access, this provides a start.
Others are restricting their schedules, making Medicare patients needing non-emergent services, wait at least two or three weeks for an appointment.
Both of these approaches require that your practice make the patient aware of why your office is delaying or not accepting new Medicare patients. To many patients the relationship with their doctor is very important and can survive these financial issues. Other patients will not understand or care what problems you are having, and may threaten to quit the practice.
No matter what path you take, it will be difficult and require commitment from the office. Change is never easy and with a Urology practice, customer service and patient comfort are the long term goals of the practice . Remember that any move that you make in this regard, is targeted to provide better long term care by providing the physician office with the financial means to stay in business and pursue reasonable lifestyle choices.
Without a push from a large constituency the system is bound to change for the worse for physicians. It is time to take action. If as a group, physicians through action send a message to the leadership that enough is enough, change would be enacted. It is time to consider your status with this program.
