To the relief of doctors across the U.S., federal lawmakers have now agreed to a tentative deal that delays the 27.4% cut to Medicare physician payment rates. As long as the deal goes through, the current rates will be extended until 2013.
Concerns over the “doc pay cut” measures have been plaguing providers, so the agreement is welcome news to the healthcare industry. But some docs are disappointed with the deal. Congress will still need to revisit the payment issue by the end of the year to reach a real resolution, and worries over the adequacy of Medicare reimbursement rates remain.
Since the start of 2012, Power Your Practice has been investigating the complicated relationship between physician providers and Medicare more closely. A few weeks ago, we published a story that discussed how many physicians are considering completely disenrolling from the Medicare system.
To examine that idea a little further, PYP recently got in touch with Jane M. Orient, M.D., Executive Director of the Association of American Physicians and Surgeons (AAPS), to get her thoughts on physicians’ best interests when it comes to Medicare.
The AAPS is a non-profit organization that considers itself nonpartisan but espouses conservative viewpoints on political issues related to the practice of private medicine in America.
AAPS promotes the concept of physician nonparticipation in Medicare as part of its goal of “preserving the sanctity of the patient-physician relationship and the practice of private medicine.” Dr. Orient has published many articles on Medicare, including a recent piece on Medicare disenrollment.
PYP: Your organization, the AAPS, has consistently advocated physician nonparticipation in Medicare for years. Have the recent melee and last-minute legislation surrounding the 27% doc pay cut caused the AAPS to support nonparticipation more fervently?
Dr. Jane Orient: We have always supported nonparticipation on ethical grounds: physicians should work for their patients, not for the government or third parties, and benefits belong to the patient not to the provider. As the program has become increasingly complex and punitive, as well as nonremunerative, more physicians are interested in nonparticipation.
PYP: If a physician in general or family practice came to you and asked whether he should disenroll from Medicare entirely or just opt-out, which approach would you encourage more?
Dr. Orient: We provide information about the options. Disenrollment has advantages, but is a gray area of the law rather than a safe harbor.
PYP: Since Medicare provides so much funding for physician residency training programs, do you think there’s anything unethical about physician nonparticipation in Medicare? Isn’t refusing involvement in the Medicare system sort of like not paying on a student loan?
Dr. Orient: No and no. When you take out a student loan, you sign a contract agreeing to repay. When you enter a physician training program, you work at less than minimum wage for years and do not sign any contract of indentured servitude (which I believe would be illegal) for the rest of your life. Training programs do take a lot of government money, but it goes to the program, not the residents. It would be interesting to see just how it is spent – I’ll wager it has little to do with the process of educating the residents, who learn primarily by working under supervision. In any event, doctors my age served in programs that were not recipients of much federal largesse.
PYP: What changes would have to be made to the Medicare system to change AAPS’ stance favoring nonparticipation?
Dr. Orient: The AAPS position is based on the principle that physicians should not work under circumstances that tend to interfere with physician judgment or that tend to diminish the quality of care, not on specific problems with Medicare fee schedules, etc. We believe that third-party payment is the basic cause of our problems, not the solution. This is to be distinguished from true insurance, which simply reimburses the subscriber for a financial loss under the terms of the insurance contract.
PYP: Can you foresee a physician-friendly Medicare system becoming a reality in the near future – say, within the next five years?
Dr. Orient: No. It only gets worse. More and more costly administrative busywork, more bounty hunters out to extract huge fines, more federal prosecutors determined to imprison physicians for coding errors, more interference with physicians’ decision-making. Medicare is bankrupt and has at least $50 trillion in unfunded liabilities (promises made that cannot be kept). Unless politicians start telling the truth about it, they will continue to devise ways to restrict care and scapegoat doctors.
Would you consider disenrolling your practice from Medicare?
Dr. Orient’s responses to the above questions represent her opinions and the stance of the AAPS on Medicare. Power Your Practice does not advocate for or against physician opt-out or disenrollment from Medicare.
