More Medicare Thoughts

[Guest guest]

In my upcoming practice, I will not have any contracts with any insurance companies, and I will not contract with Medicare. This, in addition to opting out of Medicare. I refuse to play the insurance game with experts who have greater resources and their own interests in mind.

I will charge what I believe to be fair fees for my services, but I haven't figured out what that is yet. I will provide superbills to those patients who have private insurance, and I plan to hire my former business manager on an hourly basis to help me troubleshoot this in the beginning.

Yes, I know this will potentially limit the number of patients, especially older and indigent ones, in my practice. But I will offer an experience, that which you all are offering to your patients as well, along with an integrative holistic approach.

I will hopefully float this whole thing by my already established medical acupuncture practice which is doing a little better than paying the bills. But I also serve as medical director of our local hospice, and I moonlight at local urgent care centers when needed. So, I have a little bit of a safety net.

Most importantly, I am not bound to the need for success based on previous models of busy practices or financial goals. My criteria for success are a daily enjoyable practice, satisfying the healthcare needs of my patients, and making this novel model of practicing medicine work. If it doesn't work, I will think of something else.

This last statement may sound crass, but it is the mantra I have held to and the one that has sustained me in a very interesting and challenging professional experience so far. I am more than my training, and I believe that I have much more to offer than medical advice. I feel I am more led to what I am doing, and what I am about to do, than in control. Yes, it is a spiritual journey, so my goals are set accordingly.

I do not know if this area will support me. My weekly column in the local paper has given me a presence and familiarity in the community that no amount of advertising would give. And my classes of Chinese exercises that I give at cardiac rehab has already generated interest in more classes open to the public, which I have held off on due to time contstraints.

I expect very slow growth in my practice. In fact, I will see to it, so that I can adapt at a pace at which I am comfortable. I have mild ADD, I believe, and my right brain has finally gained a edge over my left, so planning for projects like these takes me a long time.

Charlie Vargas

New Mountain Medicine

lin, NC

With regards to your planned new integrative practice, are you saying then that you will be cash only (you mentioned the benefit of 100% reimbursement at time of service)? If so, how did you decide that people will be willing to pay cash, especially if they are also already paying for health insurance? It always sounds tempting to dump all of the insurance companies but I still am not sure people are ready to buy into that concept (at least not where I practice). I’m always interested in hearing others plans & how they came to these decisions.

-----Original Message-----From: [mailto: ] On Behalf Of Charlie VargasSent: Monday, October 03, 2005 7:02 PMTo: Subject: Medicare Thoughts

I'd like to weigh in on this one. I plan to opt out as of 01/01/06. The fact that Medicare is one of the highest payers is, to me, bad news, not good news. Medicare patients are older, more complicated, on more meds and at risk for more problems than younger patients, and the government is planning to decrease reimburesment significantly over the next several years.

I have heard that they do reimburse fairly promptly, though. That is, if you bill electronically, following HIPAA regulations and the latest codes since their last updates, which occur frequently. You have to charge what they tell you to, and they can audit you, both for current charging and coding practices and retroactively.

The opt out option is pretty heavy-duty, though. It lasts for two years, and then you have to do it again if you want to. You cannot bill for anything Medicare, nor can your practice or partners on your behalf if you opt out. So be mindful of SNF or home visits, for example. If, however, you work for a hospice like I do, then they use a different UPIN than mine, so they bill Medicare directly. My financial contract is with the hospice, not Medicare in this case.

I choose to opt out of Medicare, and I plan to open my integrative family medicine clinic in early 2006. I accept the consequences in terms of limiting my practice among more elderly patients, which I regret. But, at the same time, I accept the consequences of a 100% reimbursement experience at the time of service, real time documentation, and no red tape, denials, appeals, declining reimbursements, audits and HIPAA stuff.

Charlie Vargas

lin, NC