Medicare Opt-Out: Greedy Doctors or Good Business?

Quit Medicare – here’s how.
Recently I received a medical journal informing doctors how to opt-out of Medicare. At least for now, doctors are permitted to make this decision. 
What is opting-out anyway?
To receive payment through Medicare, doctors must sign a contract agreeing to Medicare regulations, including a fee schedule. There is no negotiating these fees – it’s take it or leave it. With the vast majority of individuals over 65 covered through Medicare, there has been a great incentive to participate in the program. In return for agreeing to discounted fees, doctors have ready access to a large patient base.
Lately, however, the low fees are getting to the point that they barely cover the cost of providing services. With the 21.3% Medicare pay cut threat occurring at least 5 times in 2010, doctors are re-thinking the merits of continuing in the program.
But opting-out comes at a price.
If a doctor wants to opt-out for a particular patient, the doctor MUST opt-out for EVERY Medicare patient, for a minimum of two years. Physicians who opt-out are not subject to the charge limits Medicare imposes. They are free to charge Medicare patients whatever they like. Under this scenario, doctors are required to enter into written agreements with every Medicare-eligible patient, advising them that Medicare will not pay for any services from that particular doctor.
If a doctor is only making enough to cover rent, insurance, supplies, and staff (with nothing left in the way of personal income) it only makes sense to make a change.
How will this effect patients?
Medicare patients will still be able to see their physician of choice, if they agree to sign a written agreement regarding the opt-out.  They will be required to pay the physicians regular charges.  
This does not prevent patients from seeing other doctors who are still participating in the Medicare system. For low-ticket items, such as office visits, paying for services is usually affordable. For high-ticket items, such as a heart by-pass, most patients will have difficulty paying the full price. Of course, pricing has been inflated for non-Medicare patients in order to subsidize Medicare patients. Perhaps if the under-payment issues are resolved, the actual prices will decrease.
Medicare patients may not realize that currently they do not have the right to contract privately with a doctor who is a participating Medicare physician. If your doctor stops accepting Medicare patients but does not opt-out of the system, you are not legally permitted to see that doctor and pay for services.
So what’s the answer?
My answer would be to work toward returning health care to the free market system. If America wants to choose socialized medicine, it will come at the expense of innovation and freedom of choice. I vote for the free market system because it aligns best with the reality of human nature: we all look after ourselves first. Though we should love our neighbor as ourselves, when we are forced to put our neighbor’s interests above our own, the inevitable result is lowered motivation to do anything. Maybe this is wrong, but it is reality.

Copyright © 2011 Cynthia J Koelker, MD – All rights reserved

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One Response to Medicare Opt-Out: Greedy Doctors or Good Business?

  1. Cynthia Sherlock says:

    Doomsday approaches.

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