Leaving Las Vegas: my story of giving up a bad relationship with Medicare

Well, it’s official.  I have now become a statistic on the road of meaningful use.  I’ve joined the masses of physicians who have already dumped Medicare.  Sent out the official notification letters over the past weekend to the complex behemoth of a government-run corporation.  My “out” date will be July 1, 2011, and it can’t come soon enough as far as I’m concerned.  Goodbye EMR stimulus carrots, which I’m betting are sure to be more than providers bargained for, and hello again to freedom!  No more glorious $44,000 (or a small portion thereof that might eventually have come to me since I only make a small amount from Medicare, comprising 6% of my patients).  No more working twice as hard (the elderly are some of the most complex patients after all!) — or more — to be rewarded with dwindling payments for a non-dwindling quality of service.  Other than simply for the government to save money, there really is no good reasoning I have witnessed that justifies payment reductions to subspecialists.  The cost of services and technology for providing such services to the elderly is not getting cheaper.

There is no ability to negotiate payment rates with Medicare because Medicare is government-authorized to make its own rules and be above negotiation.  In other words, they have all the power, and providers have none.  None, that is, except for the most important power of all.  Eventually, as more and more subspecialty providers visualize the writing on the wall, I have a feeling that Medicare may doom itself.  What will life be like for seniors who who must travel great distances to find doctors who will play by such aweful rules?  I think some insights are warranted into how a dwindling subspecialist provider population in the coming years will really affect seniors in need of increasingly complex care.  A discussion of such topics and how they relate to electronic medical records might be interesting.  Hmm…

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine.  Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.   He can be reached at doctorwestindc@gmail.com.

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

4 Comments

  • Great article!

    You will also see the scenarios of people drastically cutting back on Medicare patients. I stopped doing oncology because most cancer patients are elderly, ie Medicare patients. I’ll eventually stop taking on new Medicare and also become “nonpar” which means that I can charge 15% above a limiting charge and force patients to pay up-front. If my profit is cut past a not-yet-placed line in the sand, I’ll drop even my long-time patients too (yup, even my mother).

    At the end, it’ll be the Medicare patients that suffer the most- they will find it very hard to find a patient.

  • Thanks Al! I enjoy reading your posts in MD magazine and have even blogged on the latest one. I agree that it’s the patients that will pay the price, unfortunately.

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