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I always find David's take in this area to be insightful and thought-provoking. I think his point is that when we make the calculation to participate with Medicare or Medicaid, we do a cost-benefit analysis. In the past, much of the discussion centered on the size of the benefit (e.g. was the fee schedule satisfactory). There was always a "cost" in the form of "the hassle factor". It seems that now the ante has been raised. Incentives increase the potential income, but the "costs" in terms of energy and time expended, as well as compliance with rules and regulations, have increased as well. We all need to re-think the analysis periodically. There is no right or wrong; each of us must reach their own answer.

And if 2 1/2 cents a box is a money loser...you can't make it up by increasing volume.