May 5, 2016
Hello Dear Concerned Colleagues,
I agree with Dr. Jane that Medicare patients (as have we all who have worked in the US) have had money taken from their paychecks their entire lives and are in effect conscripts in the Medicare Army; however, as we all know, government flagrantly broke the promise it made to not interfere whatsoever with the practice of medicine whatsoever including the administration and financial aspects.
Presently, government is expanding its conscription of seniors to include all patients who have healthcare insurance, whether it is Medicare, Medicaid, or Commercial via MACRA.
The Feds made buying insurance a federal law, so the only people free of their conscription are lawbreakers, who resisted buying the insurance and instead are penalized.
At any rate, is it the physician’s duty to enable the system effectively sanctioning government’s broken promises, overreach, and failed plans? Or is our duty to better serve our patients by refusing to do so, as we innovate and forge new and better ways to care for our sick. I contend the latter.
Fact is, in ophthalmology (as I’m sure with every specialty) there is incredible technological advancement abounding- including intraocular lenses that correct refractive error at the time of cataract surgery and laser cataract surgery that not only corrects astigmatism but is shown by numerous studies to produce more predictable outcomes and is safer for patients with a clinically significant decrease in occurrence of capsular tears and other intraoperative complications.
Yet, Medicare covers none of this for patients- only old style lenses and no laser technology. Patients who desire such technology must pay on their own over and above what Medicare charges. I have developed a fee schedule whereby I can do the cataract operation utilizing the new laser technology and lenses for close to what they end up coming out of pocket for if they do see a Medicare participating provider. My fees are transparent and reasonable. Patients can choose to stick with what government spoons out or upgrade and stay in my care for the perceived and real value of our patient-physician relationship, accessibility, utilization of state of the art care, and most importantly freedom from government unproven rationing, denial, restriction, data collecting, and overall violation of their medical care.
Further, I believe few doctors understand the complex Medicare insurance system. For example, I have a group of Medicare patients who have AETNA as a secondary insurer whose benefits cover 100% when they see an opted out physician and file out of network with their AETNA secondary policy. Even Tricare covers 20% if they see me opted out and then file. Supplements will not provide out of network benefits in most cases, BUT Medicare Advantage plans WILL provide out of network benefit up to 80% in many cases. Also, the patient can use their Part B to cover the ASC costs of goods and services and anesthesiologist if he/she has not opted out. Worst case scenario it costs them $800.00 to have me do their operation including 3 months post op care. If they choose laser or lens upgrade it costs them the same or less than seeing someone else who accepts assignment. I know this is complex, but we must know what is going on to best work for our patients within the existing system as we create the way to work without. At times I feel we’re headed toward an underground railroad for patients of sorts.
Yesterday I saw a Medicare patient who is experiencing a severe exacerbation of her rheumatoid arthritis that chooses to see me- as she waits 7 months to get in with a participating rheumatologist. She calls their office daily for a cancellation and has been able to get her appointment moved up to 5 weeks from now. This is Canada/VA style delays or worse. I am seeking an opted out rheumatologist with a reasonable fee schedule she can see- there’s not one in San Antonio. Think about that a second. The Medicare HMO patient must wait months to see the assigned Medicare HMO doctor. All other Medicare providers not in her HMO would be committing fraud if they saw her-she can only get in and see me because I have opted out. I could go on… I have given this heart wrenching thought and believe I’m serving the “conscripts” better because I have opted out.
I have more time with my patients, who value me- they don’t just regard me as an entitlement. I feel better physically, mentally, and spiritually.
My bank account and surgical volume doesn’t look better, but I’m working on that as I learn more, educate more, and move my new practice model forward.
I love the dialogue we are all having now. I have never felt better than being out from the government boot and able to freely and individually see my patients. Amazingly, opted out, it is even legal for me to choose to see them for free. Yes, it is a perverse system. I feel a little less perverse, a little less oppressed and abused. It takes immense communication and education of patients and staff, but it can and must be done. My patients thank me and ask why more doctors don’t do the same.
I fear the central planners will continue to close doors on our underground railroad but until then I’m digging new tunnels as fast as I can. I hope and pray there is a massive movement of physician colleagues to jump on the train with me.
Best to all,