Obamacare, MACRA, Medicacre and Opting-Out: form Orwellian Chill to Shakespearean Chuckle

In this cowardly new world of government mandated “Meaningful Use” electronic medical records and mandated adoption and application of World Health Organization derived ICD-10 codes to billing, it’s nice to trade the Orwellian chill for a Shakespearean chuckle every once in a while. Today is one of those days.

I am a physician and surgeon in private practice in Texas. Because I refuse to adopt and apply the costly, impractical ICD-10 codes to my practice, as of October 1, 2015, I could no longer file a claim for my services with any HIPAA covered entity- which includes any entity that transmits healthcare data electronically, which therefore includes Medicare, Medicaid, and All private insurance companies in existence. Because “Meaningful Use” electronic health records are not proven, are untested, are potentially dangerous to patients, and are not suitable for actual medical practice that values the actual patient-physician relationship, I won’t buy and implement them either. As a result, I would be severely penalized monetarily and publically humiliated with a bad physician “Composite Performance Score” by our government overseers at CMS were I to stay in this losing game and subject myself to the new Alternative Payment Models (APMs) and Merit Based Incentive Plans (MIPS) given birth in the newly passed MACRA law.

Supported by most state, county, and specialty medical societies including the AMA (not by AAPS) and passed with broad bipartisan support in the House and Senate (not by Senators Ted Cruz or Marco Rubio), MACRA was touted as the promised “Doc-Fix” for the failed SGR fiasco, but in reality MACRA usurps almost completely any physician autonomy to practice medicine, virtually eliminates fee for service, and all but obliterates the private practice of medicine in the USA. I know; I read it, called it out, and was disparaged by the very groups that are now themselves calling for repealing or delaying many of its central features, such as Meaningful Use and so forth. I serve my patients. I honor the Hippocratic Oath. I will not my thrust aside my deeply held medical ethics to grovel for third party crumbs. Therefore, I opted out of Medicare and terminated all agreements with private insurance on October 1, 2015.

70% or so of my patients have stayed in my care and most thank me for my position. They ask me why more doctors are not doing the same. I cannot answer for them, although I wrote an article which was published in the recent edition of the Journal of American Physicians and Surgeons that bears reading entitled, Abuse of Physicians: The Battered Physician Syndrome. As for me, I serve my patients not big government or big insurance. I provide my patients with a transparent, reasonable fee schedule for my individualized, confidential, state of the art surgery and care.

Only about 1% of our nation’s physicians have opted out of Medicare; only about 9-something thousand have opted out of about 900-something thousand who accept Medicare. Of ophthalmologists, the number is less than 40 as of the latest report I can find. So, I am one of a rare few. I also know what a fiasco dealing with CMS/Medicare is as evidenced by the disastrous rollout of the government’s own Healthcare.gov website but two years ago and the fact that the government’s own accountability office (GAO) reported that when physicians’ offices call CMS (Medicare/Medicaid) to get information about patient billing and collecting, they are given the wrong information over 95% of the time. How can I have any confidence that my opt-out status will be dealt with accordingly? Accordingly, I followed the “How-to” instructions to opt-out of Medicare to a Tee!

I used the Medicare Opt-Out Affidavit provided by Novitas, the Medicare provider for Texas and a few other states, and thank goodness I sent everything via certified mail. The affidavit must be filed with the designated agent of the Secretary of the Department of Health and Human Services (in Texas that is novitas), no later than 10 days after the first contract to which this affidavit applies is entered into. Because I knew I could not legally file claims after October 1st, because I refused to implement the government’s baloney, I executed my opt-out affidavit August 28, 2015, sent it to Novitas, and received the Certified mail domestic return receipt stamped: “Sep 3, 2015 Medicare Mailroom.” As of today, I have been opted out since October 1st but still await a written acknowledgement as I requested in my opt-out letter.

Many of my patients now file claims for themselves directly with their insurance carrier for my services as an “out-of network provider”, and Medicare patients sign an affidavit that they will not file for my services with Part B Medicare, but they can file with their secondary insurance if they please. Some of the secondary insurance companies want a copy of the letter acknowledging my opt-out. I still have not received this letter. So I called.

After multiple prompts and layers of non-human, computerized interaction, I finally got to speak to a representative who informed me it routinely takes 60 to 210 days (that’s 2 to 7 months) for them to get to it once it’s submitted. She said it was “in Que” to be in a process to be assigned to a credentials team. She said all opt-out affidavits are assigned to a team. I asked how many physicians were now opting out? Is it a massively, growing number? (in which case it would be newsworthy.) I asked how many people were on the “Opt-out” team? Is it a team of one or one hundred? Was it just another example of government ineptocracy ? Where was I in the process? Who was my credentialer? Who was on my team? She said she did not know, but if she did she could most likely not give me the information. She said “I see a letter from you but no affidavit.” I said “that’s the affidavit!” She said, “Where did you get that?” I said, “I downloaded it From Your Website!” I continued… ”I sent the opt-out affidavit certified mail, and I have a receipt!” Begrudgingly, she looked it up and said, I see a receipt for September 8. I said “My receipt clearly says September 3.” She said “Well, the 3 kinda looks like an 8, and it’s a computer entry error: it got entered as an 8.” I said “Precisely! That’s why I won’t do the unproven, untested , mandated electronic health records! Can you imagine if my patient got dosed 8 pills instead of 3 because of a computer error.” Then I said “I want to speak to your supervisor.” After a long hold the supervisor clicked in. I asked for her name. She said “My name is Mrs. Clinton.” I chuckled, of course it is. She could not help me, but she took my number- which I hope will be keyed in correctly. Fortunately, it doesn’t contain any 3’s or 8’s. I’m now sitting, waiting for Mrs. Clinton’s call…

Just kidding.

I wrote this instead, while I waited by the silent phone, realizing that I am SO HAPPY I OPTED-OUT of this insane mess. I’m not waiting any longer. It’s the same old mess.

Please, dear colleagues, wise up and follow suit. Dear patients, thank you for staying with me. For those of you who left me, I will welcome you back when the system lets you down or when you understand the realities of government run “quality, affordable healthcare.” Or you can continue waiting for Mrs. Clinton to pick up the phone.