Opt-out letter to my medicare patients

July 6, 2012






To all my present and future Medicare patients:



Most of you know me by now. In fact, most of you have known me for many years. As your physician, I greatly value the trust you have placed in me and I am dedicated to honoring that trust by providing you with the highest quality care and personal attention you deserve. But the healthcare system is changing, and in my opinion not for the better. Healthcare reform has made its way through the Supreme Court. But the fighting still continues. Both political parties are still battling out whether it's good law or a bad law. Honestly I am tired of being yanked back and forth between the two parties.



For many years, I have been deeply troubled by the changes that have taken place in our health care system, especially with private health insurers. Not a problem. I stopped working for them in 2008 and instead worked directly for my patients. The continued growth of my practice along with the feedback I get from my patients has proven it was the correct decision.



But there is not enough time in the day, week, month or year to wait for political parties to try to fix the healthcare system that they broke. They say they are trying to fix something, but they know nothing about how optimal healthcare is delivered. Both major political parties just keep getting in the way. So I have decided to create my own path.



So as of July 1, I have removed myself from participation with Medicare.



This is known as "Opting-out". Opting out allows me to provide the continued patient centered individualized service to all my patients regardless of their insurance. I am now free of many burdensome government regulations that not only distract from direct patient care but greatly increases its overall cost.



There is a caveat. In order to be treated by me starting July 1, 2012, it will be necessary (as dictated by Medicare) for patients covered by Medicare to sign with me a private contract. This is not a contract that I wrote. This "Medicare contract" comes directly from a Medicare template to ensure that we have a mutual understanding and respect for each other and our doctor-patient relationship.



You continue to have the freedom to choose your doctor. No one is being forced to do anything that they do not wish to do. I have made the choice, as a physician, to practice medicine in the manner in which I believe best serves my patients' healthcare needs. Continued participation in Medicare, in my opinion, interferes with my ability to perform these duties.



Here are some things that will not change:



I am still able to refer you to others that participate in Medicare.

I am still able to prescribe your medications as before.

I am still able to order lab testing and radiologic studies as before.

Medicare will still cover all outside testing and consultations that it did before

Medicare will still cover any emergency room or hospital visits

Medicare is still necessary for you to receive your care outside of my office and I will do the best I can to help you utilize your coverage.



Very little will change other than my freedom to do more and offer you more than when I was a participant in Medicare.



So what now?



If you have not already done so, I ask only that you schedule a no obligation 5-10 minute Medicare meet-n-greet at my office to review a few options that will allow us to continue to care for you, including our Optimal Wellness Plans which not only limit your financial exposure, but also provides more preventive and wellness opportunities for you. During this Medicare meet-n-greet session, you may also use this time to ask all of your questions about this transition. I deeply regret any trouble this change may cause you but to continue to serve your medical needs with the high quality I like to give, it could not be avoided. While my office policies concerning Medicare have changed, my commitment to you and to providing the highest quality care remains the same!



Please call the office to schedule a time convenient for you to review all of your options.



Thank you for your time and your confidence in me and my practice over the years. I hope to continue to earn your trust in the many years to come.







To Good Health!

First two days status-post Medicare Opt-out!

It's July 2, 2012




First two days status-post Medicare Opt-out!


I can tell you I feel a sense of freedom. Every patient that walks through the door to see me, does so of their own free will because they value my service. They do not visit me because I am part of an insurance cartel. They visit me for the value I give to them! It is really refreshing.


I have spoken to quite a few of my present Medicare patients. I will get to most of them hopefully by the end of July. None of them will be abandoned. If they choose to leave me, that is their option. But I plan on giving 10-15 minutes of my time to each of them in my office to hear me out, and hear my options for them.

Since I received my officially opted out letter from Medicare, which is presently at the framing studio getting the nicest possible frame around it, I have signed 14 private contracts with patients. Almost half signed onto a wellness plan, similar to a retainer package but with other benefits.


My wellness option allows Medicare patients my services for the year for about $55/month autodebited from their bank account monthly. Married couples get my services for $90/month. But wait!!! What about all those Medicare patients on a fixed income. I have a reduced fee wellness plan version for them. So far I have not been turned down yet when I have had the opportunity to first chat in person about the reasons for dropping Medicare as well as the continued opportunities to stay within my practice.


Just a few minutes before writing this post, I received an angry voice mail message from a Medicare patient who I see about twice a year, but I get probably triple that many phone calls and pharmacy refills, etc... She never asked to speak to me. She only spoke to my medical assistant. The patient never gave my MA the opportunity to explain the options still available to her. I will get these patients as well. They are free to leave and I will arrange follow-up care for them as well as forwarding their records.


I have no issue with my Medicare population. I enjoy treating them. I learn plenty from them. I also know that many feel "entitled" to receive care for no cost outside of their Medicare premium. I value myself and my services different from that. The entitled may go elsewhere.


After the 4th, I have 4-5 more Medicare meet-n-greets scheduled to review options. I will surely let you know how it goes.


I hope everyone enjoys the July 4th Holiday!


Stay safe and healthy!!

Officially opted out as of July1, 2012

Today I received my official letter from Medicare that as of July 1, 2012, I am free to private contract with my Medicare patients. My opt-out status had been in limbo since November 2011. I first had to revalidate with Medicare ( took three tries ), and then as I moved my office, I had to submit an address change before Medicare would consider my opt-out affidavit. Now that my opt-out status is officially behind me, I can work on a set of programs/plans to maintain my Medicare population at my office. I hope to prove to myself, my patients and any doc reading this blog that participating in Medicare is not necessary to be able to provide a valuable service or services to your community. I plan on offering to meet individually with each Medicare patient to explain their new options at my office. I also will be working on a mailer to these same people. If anyone has a letter they have mailed that they would like to share....... Results: This morning I had two Medicare patients private contract with me to continue their care. They chose to join my Wellness Plan, with a reduced fee for Medicare patients on a fixed income. Other patients who have heard that I would be dropping participation have also called wanting to sign on. Will post more details and stats as I move forward.

Medicare opt out

Soon I will be opted out of Medicare. It could be as early as July 1, 2012. I will try to put my thoughts down of the trials I go through in this final translation away from third parties. Comments, ideas, critiques are always welcome. DoctorSH

Cash Transition- Jan-June 2010

Cash Transition stats by popular request


I have been asked by many colleagues on Sermo, as well as followers of this blog to post further stats of my practice transition away from third parties.

So here goes....

First some history:

Back in 2007, I was getting fed up with the third party control of healthcare. I had a "normal" heavily HMO and managed care family practice. I was exploring options that I would enjoy more. My daughter thinks I am a good cook, but my back can not handle being on my feet for too long, so becoming a chef was out of the picture.

I had a few other options to remain in family practice.

1) Continue as is, as a solo family practice doc.

2) Join a large family practice group without walls, where the group would share a taxpayer-id and other management resources, and would handle all the contracts with the third parties. Advantages included increased fees from third parties. Disadvantages included having to toe the line of the group practice. As I do not always play well with others, I did not choose this option.

3) I also explored converting my practice to a concierge model. This also had many advantages including a guaranteed salary for three years, less patients seen per day, and no dealings with third parties. Disadvantages included the high membership fees for patients that would scare off 95% of my practice, and possibly brand me as a "country club doctor". While sticks and stones can break my bones, but names can never hurt me, I decided against Concierge as I had developed many strong relationships with my patients and I truly did not want to abandon them, or make my fees out of their reach.

So I then did what I usually always do. I made up my own business model that best fit my own personal healthcare philosophy.

I decided to transition away from all third parties other than Traditional Medicare in January 2008. I also offered prepaid yearly Wellness options, some with no copays, others with small copays, as well as also allowing regular self-pay fee for service. In 2009, I moved all my Wellness Plans to no copays. My Wellness Plan fees average about 30-35% of a Concierge practice. Please make note that I do not offer Concierge services, so I do not charge Concierge fees. There is a Concierge physician in my area who does offer these services and I have referred patients to his practice who are looking for that type of service.

OK.

Enough history..

Here are some stats.

2010- Wellness Plan-Self Pay- Traditional Medicare
2007- Normal Third party dominated practice

1st two quarters 2010 revenues are now 4% higher than 2007
1st two quarters 2010 expenses are down 23% from 2007. They would be down more, but my type of practice requires more to be budgeted for marketing. The payroll expense, not including my salary is down 40% from 2007. If you do not deal with referrals, nor deal with medical billing, and see about half as many patients per day, the staff requirements drop!!

1st two quarters 2010 patient visits are just under half of those seen in 2007, so $/patient in 2010 ($126) is just under double 2007 ($64).

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Now for what I find interesting.

I calculate percetage revenues from three different categories;
1) Wellness Plans
2) Self-pay or fee for service each visit
3) Traditional Medicare and balance billing secondary insurances

Here are the percentages for each 1st two quarters 2010 for 2007---2010.

Wellness Plans:
2007 0%, 2008 43%, 2009 53%, 2010 56%

Self-Pay
2007 20%, 2008 23%, 2009 32%, 2010 32%

Medicare-secondary insurance-(third party hmo's, ppo's in 2007 only):
2007 79%, 2008 32%, 2009 15%, 2010 12%
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More interesting tidbits:

Revenues per patient visit for 1st two quarters 2010 by type of payer:

Medicare $80.89

Self-Pay (payment-at-time-of-service) $114.10

Wellness Plans (Yearly Retainer) $162.39

My conclusion: For all the docs that think that a zero copay retainer style patient will overutilize your services, I say:

1) They won't, as my practice proves

and

2) Who cares if the revenues per visit double Medicare, while allowing you more time to spend with each patient, building up trust and the doctor-patient relationship once again!!!

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Other interesting tidbits about my practice.

I presently average about 11-12 patient visits per day.

My 1st two quarters 2010 medical billing costs are about 30% of 2007.

I share office space with my spouse, who is a psychiatrist. We share one full-time employee. We have no other staff. We do not need a referral coordinator, nor a medical receptionist. We have a voicemail system. Many patients have my cell phone number for urgent or emergent situations. They have never abused that privilege.

For me, this practice style has been a no brainer, and I do not forsee myself going back to third parties. I will probably end up dropping Medicare participation within the next few years, or sooner dependent upon how bad Obamacare actually turns out.

I hope this post has fueled some thought.

I welcome any comments.