September 13, 2015
Dear Cherished Patient,
I most humbly request you take a few minutes to read my heartfelt letter to you. Whether I have cared for you for the past 20 years or you are new to the practice, I want you to understand that I value our relationship most highly and regard my service to you as your physician and surgeon as a privilege and a blessing. I honor the Hippocratic Oath and will treat you individually to the very best of my ability with dignity and privacy.
In 1965, President Lyndon Johnson signed the Social Security Act Amendments into law creating Medicare and Medicaid with the promise that the federal government would not interfere in any way with the practice of medicine whatsoever including compensation, administration, or operation of any institution, agency, or person per Title XVIII SEC.1801.
Tragically, over the past 50 years, the government’s pledge to not interfere with the practice of medicine has been broken. The law has been unheeded and continuously altered, such that the practice of medicine in the United States has been fundamentally transformed, commandeered, and all but lost.
October 1, 2015, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services of the Executive Branch of the United States federal government requires that in order to bill for services physicians must implement ICD-10, the 10th revision of the International Classification of Diseases and Related Health Problems, a medical cataloging system of the World Health Organization that includes 141,000 diagnosis and procedure codes including W56.22 Struck by Orca, initial encounter, V91.07 Burn due to water-skis on fire, V97.33 Sucked into jet engine, X52 Prolonged stay in weightless environment, V95.40 Unspecified Spacecraft accident injuring occupant, and even VO6.00xA for when Grandma gets run over by a reindeer. The costs of ICD-10 implementation are staggering, far outweigh any perceived benefit, and are a vital factor separating financial sustainability from bankruptcy for private medical practices going forward. ICD-10 implementation was fought vehemently and delayed 2 years, but ultimately, money from lobbyists representing hospitals, IT, and other special interests bought votes and trumped the best interests of America’s patients and physicians. CMS could delay this but chooses not to.
Government is now virtually extorting physicians in unprecedented fashion. If physicians do not precisely follow government rubrics and implement and comply with everything the Secretary of Health and Human Services says, we are penalized. I am not implementing ICD-10, because it is nonsensical and doing so does not serve my patients first and is not the best utilization of resources. If I implement this nonsensical, wasteful system, what won’t I do? This is my line in the sand. Therefore, as of October 1st, I will be unable to submit claims to CMS for my services to you. I will be forced to opt out of Medicare.
Just as government has broken its pledge not to interfere with the practice of medicine, it has broken its promise to you, our nation’s seniors. On April 16,2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and soon government will be means testing you and charging you increasingly higher monthly premiums for your Part B Medicare.
Government has betrayed us, but we must not betray one another. The preeminent, inviolable relationship that must be preserved exists between patient and doctor. The insurance company-customer and government-subject relationships are secondary by great orders of magnitude. I am asking you to continue in my care. I will provide you with a transparent fee schedule that is fair, reasonable, and in many cases less than Medicare. My services may cost less than those of your hairdresser, mechanic, or any other professional with whom you do business. Of utmost importance is your understanding of Medicare Parts A, B, C, and D. Part A is the hospital part while Part B is the physician services part. You can still use your other parts of Medicare even if you choose to see me outside of Medicare Part B. You will be pleasantly surprised, and in the long run you will be better served by staying in my care outside of the restrictions and wastefulness of Medicare. I will put you and your well-being first, in place of nonsensical, if not harmful, government rubrics that serve the collective good and political ruling class at your expense. I will not violate my pledge to you. Please, stand with me.
If you chose to see me, government requires you sign an affidavit stating that you understand I have opted-out of Medicare and that you will not submit a claim for my services except for emergency or urgent care services.
My choice is to violate my code of ethics and implement government–mandated ICD-10 and subsequent diktat or opt out of Medicare and serve my patients first. I cannot continue to enable this perverse, wasteful, dysfunctional system. I pray you will work with me in a new paradigm-shifting, alternate universe where you have an actual doctor and actual medical care in lieu of government-mandated “insurance” that comes with neither. Enclosed you will find my fees. My staff and I are available to answer your questions and address your concerns. I appreciate your time and consideration of this critical matter.
Kristin S. Held, MD