Originally Posted by Indy
I understand that the math isn't going to work for every practice.

Here are some prime motivators we have heard, and then the math you can consider.

Motivators:
<1>Their most complex and least compliant patients are government payer
<2>Patients that have no insurance and are compliant, but you cannot take less than the government price - that they don't pay.
<3>The increasing risk that the government comes in and destroys your practice based on their unilateral evaluation of your charting - or worse.

Considerations:
<a>How many cash paying patients could you see if you weren't seeing 1. above?
<b>How many 2. patients could you see if you could apply your judgement to what they can afford and you charge?
<c>If making the change means less patients - hours open, do you have the options to do house calls, SNF visits, or other medicine that doesn't require a full office staff overhead load?
<d>How much is taking 3. off the table worth?

For many reasons, our nation and it's medical system are headed for some wrenching changes. It irritates me that independent Doctors are the ones that expected to take it and keep saying thank you.



This is just what we did when we made the decision to opt out of Medicare, a decision that was almost entirely driven by a desire to avoid the sorts of threats that started this thread. Yes, the math did work for us. Not because we made more money (we didn't), but because our lives are less stressful and our jobs are more fun. Lots more fun. Fun is not a term that I see being used much as relates to medical practice. It makes me sad... all that work, and people end up doing something that seems to make them unhappy.

I don't agree with the idea of templates... I think they make for voluminous cookie cutter records of limited use... but I agree that they were an inevitable result of the "bullet point" method of reimbursement.

David Grauman MD
Department of Medicine
Commonwealth Health Center
Saipan, Northern Mariana Islands