Quitting Medicare: Pro and con
I appreciated your article "Thinking of opting out of Medicare" [June 20]especially the accompanying "Clip and Copy" model letter a doctor can use ["Letting patients know why you've quit Medicare"]. We will link to it from the AAPS Web site.
We hope that more and more physicians will take advantage of the opportunity to opt out so they can continue to serve their patients despite the increasing problems of the doomed Medicare system.
Jane M. Orient, MD
Association of American Physicians and
Your article failed to emphasize one very important fact. If you drop out, neither Medicare, nor most supplemental policies, will pay any part of the cost of the care you provide. Your patients, in effect, will have no insurance coverage for your services.
If that happens, you may find that Medicare rates weren't so bad after all. So don't opt out because you're losing money. You could be jumping out of the frying pan into the fire.
Roy W. Huntsman
Medical and Dental Management
It was a nice change of pace to read an article that featured physicians who did not drop their Medicare patients when they opted out of Medicare.
Our office has been one of those to take the leap out of the Medicare program, but we have not dropped any of our Medicare patients. True, we have lost some of our patients, but to accommodate those who chose to remain faithful to our practice, we reduced our Medicare fee schedule.
I've heard dozens of patients say "Good for you, Doctor," or remark how proud they were to have a physician who decided to take health care back into his own hands. Several even reminisced that this was how medicine used to be in the "good ol' days."
Connell Medical Center
Here are some additional points about leaving Medicare that might prompt your readers to take a closer look at the option.
CMS has verified that Stark II would not apply to physicians who opt out. They could own and refer patients to labs, therapy centers, etc., depending on state law. This opportunity alone may be incentive enough to drop Medicare.
An opt-out physician could remain in a group practice with Medicare-participating physicians. Some groups might find this arrangement advantageous.
Because an opt-out physician is allowed to bill Medicare for those Medicare patients he sees on an emergency basis, an opt-out physician could still take call.
An opt-out doctor's hospital privileges are rarely affected, unlike when a physician is excluded from Medicare.
It's true that a Medicare patient who receives care from an opt-out physician must pay that doctor's professional fees out of pocket. However, Medicare could still cover related services he needsincluding inpatient care, outpatient testing, etc. as long as they were furnished by participating providers. For example, a Medicare patient receiving a knee replacement from an opt-out orthopedic surgeon would have to pay the surgeon's fees himself. But Medicare could pick up the costs of the hospital stay, anesthesia, durable medical equipment, etc. related to the surgery.
Barbara Peck, JD
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Letters to the Editors. Medical Economics Oct. 10, 2003;80:12.