Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why I decided to opt out of Medicare as a provider

Natasha Deonarain, MD, MBA
Physician
November 15, 2012
Share
Tweet
Share

There’s a lake in Northern Arizona where I jog. I call it “my” lake. It used to be filled to the brim, a playground for ducks, geese, Monarch butterflies, rabbits, and squirrels. Over the years when I’d jog in the cold mornings, my lake dried away from drought, measured by bathtub rings on the boulders that surrounded it. Today, rust-colored grass fills the space where clear water once lay. The rings on the boulders are uncountable. Soon, my lake will be gone.

When I drove home last night from the clinic, I decided to set ourselves free from the drought which is drying us. I decided to opt out of Medicare as a provider.

Here’s a brief account of what’s been happening.

Medicare patients come into our little urgent care clinic in Northern Arizona, sick with multi-system disease. They hobble in from their cars or taxis, clinging to the arms of their loved ones (if they’re lucky) or all alone if they’re not, a plastic bag full of medication in their knobby hands. They’re told at the front desk to choose Option 1, 2 or 3. If they choose Option 1, they will have to pay for any additional services provided in our clinic before they leave.

People used to complain about our new policy. But when all the other primary care physicians in this rural area stopped taking any new Medicare beneficiaries, their offices filled to the brim like that lake used to be, charging their patients 6, 7, or 8 hundred dollars a year before they would see them, our patients stopped complaining. They had nowhere else to go.

The number of Medicare patients we see has increased noticeably. Their primary care doctors, now scarce, can’t see them for weeks. And the only other place left is the over-stuffed emergency room down the road.

So they come to us.

At the end of a billing cycle, our net reimbursement for most Medicare patients is about $130.00 for a new patient, $80.00 or less for an established. That’s not too much to ask, considering the difficulty in making some of those complex decisions on very sick patients who we’ve never seen before, inside the span of a short visit. But it takes 30 – 45 days for us to get that desperately needed money back into the business, after a mound of paperwork, time and cost, a 6% billing fee and the constant fear of Medicare hold-backs. Embedded inside this is the fear of missing something clinically important in that short visit; an elderly patient whose family has abandoned him and who can’t remember why he came to see us in the first place, let alone the names of his complex list of medications.

Our billing company keeps telling me that Medicare is cutting back, again. They tell me Medicare won’t pay for this, and for that, and for this, or that. It becomes difficult to tell a trembling patient straight to their face that they have a fractured ankle, and then watch them hobble out of the clinic on a broken leg, knowing that we won’t be reimbursed for the cost of giving them an expensive boot and crutches. It becomes difficult watching a chest pain patient make the decision to drive himself to the emergency room against medical advice because he’s afraid of the cost of an ambulance, knowing he could never pay it.

It’s tough, knowing that at the end of a billing cycle of 30- 45 days; we may or may not be paid our $40 or $50 balance, depending on Medicare’s new rules. That $40 or $50 is sorely needed to keep the lights on these days.

It becomes difficult to know that the provision of services by a nurse practitioner or physician assistant will come at 80% of what a physician would bill, and that $40 or $50 gets drained down to $32 – $40.

We have a great cash pay option for people who don’t have insurance. For $75, anyone can come to see us any time if they have a loyalty card, purchased at a nominal fee. They can receive any additional services of their own choice, each charged separately for very reasonable costs. For example, an x-ray of any body part is $50. An injection of an antibiotic that has the potential to save an extremely expensive visit to the emergency room and possible hospitalization is $40. Our net, after treatment of those same Medicare beneficiaries, would be around $130, collected immediately at the time of service.

There would be no additional fees to be paid to a billing company so they can play games with our government. There would be no additional fees in bad debt or collection agencies. There would be no worries about committing fraud, incident-to billing, or the miscellany of other punitive rules, policies and regulations that have become exponential as America’s health care crisis spins out of control.

There would just be a doctor and her patient and no one else in between.

ADVERTISEMENT

Like that lake where I jog in the mornings, I’m watching our Medicare program run dry. Nothing will be left of it soon but a bunch of crusty old bathtub rings, and no one else to care.

It’s the hardest thing as a doctor, a humanitarian, a human being to watch others hobble in for help that you could give, clutching their plastic bags and know that you can’t give them what they need. Providing what they need would lead to your own financial demise, and the lights in the building would go out.

It’s the hardest thing to know that very soon, all that will be left of that beautiful lake will be a field of rust-colored grass, with no living creature around for miles. The rabbits, butterflies, ducks and squirrels will be gone.

Doctors should be angry. Patients should be angry. You should be angry, too. But, it’s in these small acts, one by one, as hard as they are, that together through our pain, we can change this world.

Natasha Deonarain is the founder of The Health Conscious Movement. She is the author of the upcoming book, The 7 Principles of Health and can be reached on Twitter @HealthMovement.

Image credit: Shutterstock.com

Prev

A Medicare payment system focused on quality

November 15, 2012 Kevin 8
…
Next

Inappropriate care requests: The role of health care professionals

November 15, 2012 Kevin 3
…

Tagged as: Medicare, Primary Care

Post navigation

< Previous Post
A Medicare payment system focused on quality
Next Post >
Inappropriate care requests: The role of health care professionals

ADVERTISEMENT

More by Natasha Deonarain, MD, MBA

  • Why doctors should write poetry

    Natasha Deonarain, MD, MBA
  • The inhumanity of medical residency programs

    Natasha Deonarain, MD, MBA
  • Young doctors can set themselves up to be financially free

    Natasha Deonarain, MD, MBA

More in Physician

  • Why starting with why can transform your medical practice

    Neil Baum, MD
  • Life’s detours may be blessings in disguise

    Osmund Agbo, MD
  • Inside the heart of internal medicine: Why we stay

    Ryan Nadelson, MD
  • The quiet grief behind hospital walls

    Aaron Grubner, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How to advance workforce development through research mentorship and evidence-based management

    Olumuyiwa Bamgbade, MD
  • The truth about perfection and identity in health care

    Ryan Nadelson, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
    • Why your most heroic act might be in a department meeting [PODCAST]

      The Podcast by KevinMD | Podcast
    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 101 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
    • Why your most heroic act might be in a department meeting [PODCAST]

      The Podcast by KevinMD | Podcast
    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why I decided to opt out of Medicare as a provider
101 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...