Physicians Predict ‘BREXIT’ From Medicare

In this July 30, 2015 file photo, a sign supporting Medicare is seen on Capitol Hill in Washington.
AP Photo/Jacquelyn Martin

Physicians across the country are predicting the imposition of a new Medicare payment system will likely lead to an exit by doctors from the government-run health insurance program used by mostly older Americans.

According to a Medscape Medical News survey, four of 10 physicians in solo or small group practices say the new payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will lead to many physicians dropping out as Medicare providers because of its “punishing penalties,” the survey notes.

As many as 59 percent of physicians in smaller practices (fewer than 25 clinicians) also said they expect to receive a financial penalty of as much as four percent under the new rules, while only 9 percent in the same group expect a bonus and 12 percent expect no change in their Medicare fee reimbursements.

In addition, about one-third of these doctors said the result of the new MACRA regulations would cause their smaller practices to merge with larger medical groups.

“It’s extremely concerning,” said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association. “Any program like this should give physicians the opportunity to succeed regardless of practice size.”

Gilberg said the new payment system – signed into law by President Barack Obama after overwhelming “bipartisan” agreement – creates a situation in which 87 percent of doctors in solo practices get penalized financially while 81 percent of the large group clinicians actually earn bonuses.

According to Medscape:

The default mode of the compensation plan, proposed April 27 by the Centers for Medicare & Medicaid Services, is the Merit-Based Incentive Payment System, or MIPS, and will initially cover the vast majority of physicians. MIPS is structured to award performance bonuses as high as 4% to an estimated 412,000 physicians and other clinicians in 2019. Another 346,000 clinicians, mostly in practices with fewer than 24 members, are likely to be penalized by as much as 4%, partly because they don’t have the support staff to shuffle through MIPS guidelines and data entry, or help achieve patient outcomes on which their performance will be rated.

“It is impossible to practice medicine under this rule, for ethical and practical reasons, said Association of American Physicians and Surgeons (AAPS) executive director Dr. Jane Orient, adding:

The rule makes it impossible to protect confidentiality, and one is in a constant conflict of interest: What is best for the patient may be bad for the financial viability of the practice. It would take a dedicated team of legal specialists to even attempt compliance. Full compliance is probably impossible even with such a team, which is beyond the means of a small practice.

In their comments on the proposed rule, AAPS members specifically noted the rule forces doctors to convert to Electronic Health Records – even for confidential mental health records – and allows government access to those records without the consent of patients. The physicians raise specific concerns about information regarding patient gun ownership, which could be incriminating to patients.

Financial analyst John Graham wrote at Forbes in April of 2015 that MACRA was a “fiscally irresponsible approach to increasing the amount the federal government spends on Medicare’s physicians’ services.”

Graham observed that with MACRA, lawmakers of both parties approved what amounts to an Obamacare-like federal control of Medicare.

As doctors either leave the program altogether or allow their smaller practices to get swallowed up by larger, bureaucratic-type groups, all Americans will be paying more for the health insurance program that is set up like a ponzi scheme.

Enacted by President Lyndon Johnson in 1965, Medicare shifts the cost of healthcare for current older Americans on to younger working Americans. Most people who understand the problem isn’t that younger people shouldn’t help older people, know that such a program can’t be maintained since Americans are now living way past age 65 while younger workers will not have the program there for them when they retire.

“Longevity has definitely improved and, in addition, the baby boomers didn’t have enough children,” Orient tells Breitbart News. “Now we’re down to two or fewer working people supporting each and every retired person. This is a burden the younger generation cannot sustain.”

In a report on Obamacare’s sixth year, Heritage Foundation health policy expert Robert Moffit also noted that Obama cut $715 billion from Medicare over the next decade to help pay for Obamacare.

“It is logically impossible to cut payments for Medicare services without affecting seniors who depend on those services,” Moffit writes, observing that in their 2015 report, the Medicare Trustees confirmed the Center for Medicare and Medicaid Services (CMS) Chief Actuary’s concerns about the severe impact of Medicare healthcare provider payment reductions on older Americans’ access to healthcare.

The CMS Actuary projected that by 2040, most hospitals, skilled nursing facilities, and home health agencies will become unprofitable, leading to a significant reduction in access to healthcare for older Americans.

Dr. Kristin Held, a Texas-based ophthalmologist, explains to Breitbart News how MACRA will create higher costs for older Americans on Medicare Part B – which covers physicians’ services and outpatient and ambulatory surgery.

She explains:

So, here you have people who paid into Medicare during their working years, and now, all of a sudden, in order to keep Part B they’re going to be paying $400 per month each for a Medicare plan that is also more restricted. A married couple already retired could be paying $800 per month for Medicare Part B. They will absolutely want to consider a private contract arrangement with their doctor.

Held herself opted out of Medicare as a physician last October, even though her ophthalmology practice sees many older Americans for treatments of cataracts and other eye diseases. She says some of her patients have “Medicare replacement plans.” In addition, her office tries to help patients understand what kind of coverage they have and help them file for reimbursement for themselves.

“That’s really more appropriate, because a patient’s agreement is with his or her insurance company,” she says. “My agreement is with my patient, not the insurance company. I tell my patients I am out-of-network and I work for you, but I will help you work with the insurance company you’re paying.”

“So, I might say to a patient, ‘You saw me today, and your copay would have been $65, but you have a follow-up visit at my office for $45. You saved $20 by not using your insurance.’”

Held warns people about to turn 65 that Medicare does not cover technology and innovation in ophthalmology. She explains how she works with patients who have Medicare:

If a cataract patient wants to have a special lens to correct astigmatism so she would not have to wear glasses after the surgery, Medicare will not pay for that lens. If she wants to have laser surgery, Medicare will not pay the additional cost for a laser, even though the outcomes are more predictable. So if a patient with Medicare comes to me to do the surgery, my fee includes the laser and the upgrade to the special lens. When I’ve compared my fee to that of my colleagues who accept Medicare, I am $1,000 less per eye than a colleague of mine five minutes away who is a Medicare participating provider. Patients who are smart and want that technology can come to me and file a Medicare opt-out form so they can private contract with me. They can use their Medicare Part B at the surgery center where I perform surgeries, pay me my direct fee, and save $1,000 per eye in this situation.

Held urges Americans who are on Medicare to explore options for private alternatives.

“People have to hunt around to find private health insurance plans that will take on older Americans who otherwise would be on Medicare Part B,” she says. “Health-sharing ministries were exempted from Obamacare and they often take on Medicare patients. There are other, more creative options out there, but people have to be willing to look for them if they really want to save money. Of course, we also have to be vigilant to ensure the government doesn’t shut this option down.”

Moving beyond the concept that “someone else” will pay for one’s health care means there will be more of a market for private insurance companies to contract with older Americans and for direct pay without the use of a third party payer system. If patients were able to purchase health insurance across state lines, competition among the insurance companies for that market would drive prices down as well.

Leftwing media, however, continue to pummel Americans with images of “throwing Granny off the cliff” whenever realistic alternatives to Medicare are raised.

“Some people are looking at Medicare as it has been, not as it will be under the new rules, which don’t even really kick in until 2017,” preventive medicine physician Dr. Lee Vliet explains to Breitbart News. “When people see that Medicare will be broke and thus will be restricting many more procedures that they may need, as well as hospital readmissions, etc. – and it will get worse when Obamacare’s Independent Payment Advisory Board gets here in 2017 – they will want some other options.”


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