@ Jimmie
my rationale for un-enrolling in medicare if I decide to do it:
1) reimbursement barely covers my per-patient minimum required income to cover office over-head expenses, and when the
SGR cuts finally come to fruition I will no longer afford to see medicare patients.
2) threats of SGR-related cuts and proven history of congressional and presidential failure to fix the broken formula. They will eventually stop delaying the cuts and we won't get paid anything worth our efforts and educational training to accept their "payment." This may be a moot point under the ACO model of payments, in which case I won't be able to see these patients anyway because our local ACO is open ONLY to the local hospital owned practices. I'm not allowed to participate unless they own me, thus I would have to subscribe (pay) to belong to a national ACO billing service and I refuse to sell my soul to this type of "health plan."
3) CMS lies and tricks to get us involved in programs by 1st "incentivizing" us to participate then "requiring" us to participate under threats of payment reduction for non-participation. Examples include: PQRI/PQRS, ERx, Meaningful Use. Like many other docs I know, when PQRI/PQRS was offered in 2008 (+/- a year), I predicted successfully that within a few years they would penalize us for non-participation. Starting 2014, this becomes reality.
4) Stage 2 and 3 of MU requirements that are EXPONENTIALLY more challenging and time consuming to meet. Coupled with incentive pay that is not even close to covering my expenditures to meet the requirements (for me stage 2 will reimburse $,4000 and $2,000 in my final 2 years of the 5 year MU incentive) thus resulting in a return on investment (ROI) of NEGATIVE DOLLARS when you consider my time and my paid staff time to meet their "measures of good practice."
5) 2014 represents the year in which failure to participate and produce data for PQRS/PQRI and MU will result in 1-2% penalty for non-participation. It's already happening for ERx.
6)threats of audit and the risk of getting falsely accused of inappropriate billing practices by the governmental gestapo called the General Accounting Office (GAO) are at ALL TIME U.S. HISTORICAL HIGHS. If you subscribe to CMS email alerts, you know that in January they proudly released 2012 reclaims data in which the GAO spent 1 Billion dollars (with a B) on reclaiming Medicare payments, and for the 1st time in U.S. history turned a profit. They raked in over 3 Billion (with a B) and prosecuted over 1,200 people and about 200 institutions. Let me be clear, I do not commit fraud. But I know a doctor in Maine who was falsely accused by the GAO and he WENT OUT OF BUSINESS AND INCURRED MASSIVE DEBT DEFENDING HIMSELF. This is not fair. This is not just. This is fascism in practice, right here in the good-ole U.S. of A. The home of the brave, and land of the free. I LOVE MY COUNTRY but I HATE these governmental practices that have NO REGARD for the personal debt we all incurred getting our career training and PERSONAL SACRIFICES we all made to learn doctoring and care for others, giving of ourselves DAILY. And the government comes around and F's us over. Mark my words, the GAO will not stop. They will spend more this year and more next year to get more reclaims payments.
7) inconsistency in government sponsored health plans
The down-side: i will feel sad and guilty that many of my medicare patients won't be able to afford to see me for cash payments (I will offer them reduced fees of $40-75 office visits), people I've cared years for. But even with my lowered fees many won't be able to afford it. When the ACO model of payment fully kicks in 2014 for Medicare this may be a moot point because they will end up getting assigned a participating provider (which won't be me). I know CMS says Medicare patients will have the right to choose......but you and I know damn well that with their track records of lies and deception this choice will turn into a choice to see "participating providers," and later that "choice" will no longer be offered. Instead they will be assigned to doctors without choice.
I say the following not to be offensive, rather somewhat in jest and somewhat with serious undertones: If any of you readers think I'm being paranoid, then you are foolishly drinking the cool-aid and need to undergo psychiatric testing. The government will come after us in the form of audits and "reclaims reviews." Be scared, be terrified. On the one hand they say "we need more primary care doctors and are increasing their reimbursements." On the other hand they just cut our payments by failure to agree on the Sequestration bill, and will eventually cut via the SGR formula, and they are putting us in chains and screwing us over for the YEARS of sacrifices we made.
For these reasons which I believe to be rational and thought-out for many months/years are the reasons I am making plans to withdraw from medicare in 2014.
respectfully submitted.
P.s. my use of capital letters is not "yelling," but simply for emphasis.
