Re: Re: Medicare OPT-OUT .... how's it going?

July 4, 2006

Opting out of Medicare, cash-only practices, etc generally only work in affluent

areas though. I was curious, so I searched on " Rancho Mirage California " in

Google. The average household income there is $89,000/year. That needs to be

kept in mind by others considering a similar practice style. You have to keep

in mind the huge weight that LOCATION carries. In my community even people with

private insurance do not like to pay a second co-pay if I send them for a

referral. I'm not sure what the average household income is here but it is

certainly not $89,000/year.

>

> Date: 2006/07/03 Mon PM 09:42:16 EDT

> To:

> Subject: Re: Medicare OPT-OUT .... how's it going?

>

> I have been opted out since Jan 1st 2006. It is going

> well for me in my community which is traditionally a

> retirement area - lots of seniors and not enough

> primary care doctors for them. I thought my opt-out

> status would have scared away a lot of Medicare

> patients, but quite the opposite has happened. 40% of

> my patients are Medicare and they fully understand

> they cannot get reimbursed for my office fee - but

> they love the long appointments, in-depth discussion

> of their concerns, and the convenience and

> unobstructed access they have to me. I can do house

> calls because I'm not trying to dance around medical

> necessity rules and Medicare still covers most of the

> labs, x-rays, referrals, etc. I order on patients.

>

> I am not looking back and I am enjoying medicine more

> than ever. You do have to have each and every patient

> sign some sort of " medicare private contract " with you

> (we got our language from the website of the local

> medicare carrier), and you need to remember to renew

> your opt-out affidavit every 2 years - you will not be

> reminded and if you don't file it within the deadline,

> you can be " reinstated " into medicare against your

> will. The opt-out period is for 2 years, although I

> think there is a brief window to withdraw the opt-out

> in the beginning if you change your mind.

>

> Good luck!

>

> , MD

> Rancho Mirage, CA

>

> --- roxywible wrote:

>

> > So I was curious if anyone has opted-out and how it

> > is going?

> >

> > I plan to opt-out in October. I just missed the

> > 7/1/6 date so I'll wait 3 months and it will

> > give me some time to contact my medicare pts and see

> > what they want to do (continue

> > with me or not).

> >

> > It looks like (from reviewing all the data I

> > collected on the listserv) that I send in an

> > Affidavit that reviews the basic info (I have one

> > from a Cigna site) and mail it to Medicare

> > aleast 30 days prior to 10/1/6. I do not think there

> > is an official " Medicare Opt-Out Form. "

> >

> > So for those who opted out what happened with your

> > established patients? How many

> > stayed? Was there a huge migration out of your

> > practice?

> >

> > I plan to make it very affordable with a sliding

> > scale - probably 40-60 bucks for most

> > visits which is what our local Medicare pays for a

> > 99213/214 around here anyway. People

> > who are not financially strapped can pay my NL fees

> > if they stay (with my usual 30%

> > discount if they pay at time of service)

> >

> > Would love any pearls of wisdom before I jump off

> > the ship. I would assume nobody had

> > regrets and signed back on to Mediacre AFTER opting

> > out. Has anyone done that??

> >

> > Thanks in advance,

> >

> > Pamela

> >

> > Pamela Wible, MD

> > Family & Community Medicine, LLC

> > 3575 st. #220

> > Eugene, OR 97405

> >

> > roxywible@...

> > www.idealmedicalpractice.org

> >

>

> __________________________________________________

>

July 6, 2006

I don't want people to get the impression that my

practice caters to the rich and well-heeled.

In my short experience (I'm only into my 8th month) I

have noted that the biggest difference about being in

a high income area is that my rent is higher than most

of my colleagues in other parts of the country. " Low

overhead " is a relative term, and I pay a premium for

being in a high rent district. Interestingly enough -

I have attracted patients from all areas of this

desert valley, including low-income cities like

Coachella and Mecca, and modest communities like

Desert Hot Springs and Yucca Valley. I have Medicaid

patients in my practice, as well as uninsured folks

(about 20-25% of my practice). Because I am

Spanish-speaking, I attract working class Latinos -

many of whom are in service industries like gardening,

maintenance, housecleaning, etc. - some are probably

undocumented immigrants - not exactly high-income

folks. I would guess that only 10-15% of my patients

live in Rancho Mirage.

I do think that all else being equal, people would

prefer to see a doctor in a nice part of town (or go

to a restaurant in a nice part of town, or go

shopping, etc). I was new to this community and had

zero established patients, so I needed all the help I

could get to attract new patients. Besides, my wife

and I knew that building this practice we would be

" living " here at the office, so we chose to set up in

a nice area. My plan is that after I am established

(hopefully within 2 years - we have an initial 2 year

lease with an option to extend for another 2 years), I

will seek out cheaper digs (or buy an office condo so

at least I am building equity), because my hunch

(reinforced by this group) is that patients will

follow the practice because of the service, not

location.

The only " huge weight " I have felt due to my location

is on my bottom line, because of the high rent!

I sincerely believe that a cash-only practice can work

anywhere - my wife and I chose this location because

of family reasons. In other areas, rent would be less

and office fees could be commensurately lower, making

it affordable for most of the population.

Rancho Mirage, CA

--- drbrock@... wrote:

> Opting out of Medicare, cash-only practices, etc

> generally only work in affluent areas though. I was

> curious, so I searched on " Rancho Mirage California "

> in Google. The average household income there is

> $89,000/year. That needs to be kept in mind by

> others considering a similar practice style. You

> have to keep in mind the huge weight that LOCATION

> carries. In my community even people with private

> insurance do not like to pay a second co-pay if I

> send them for a referral. I'm not sure what the

> average household income is here but it is certainly

> not $89,000/year.

>

> >

> > Date: 2006/07/03 Mon PM 09:42:16 EDT

> > To:

> > Subject: Re: Medicare

> OPT-OUT .... how's it going?

> >

> > I have been opted out since Jan 1st 2006. It is

> going

> > well for me in my community which is traditionally

> a

> > retirement area - lots of seniors and not enough

> > primary care doctors for them. I thought my

> opt-out

> > status would have scared away a lot of Medicare

> > patients, but quite the opposite has happened.

> 40% of

> > my patients are Medicare and they fully understand

> > they cannot get reimbursed for my office fee - but

> > they love the long appointments, in-depth

> discussion

> > of their concerns, and the convenience and

> > unobstructed access they have to me. I can do

> house

> > calls because I'm not trying to dance around

> medical

> > necessity rules and Medicare still covers most of

> the

> > labs, x-rays, referrals, etc. I order on patients.

> >

> > I am not looking back and I am enjoying medicine

> more

> > than ever. You do have to have each and every

> patient

> > sign some sort of " medicare private contract " with

> you

> > (we got our language from the website of the local

> > medicare carrier), and you need to remember to

> renew

> > your opt-out affidavit every 2 years - you will

> not be

> > reminded and if you don't file it within the

> deadline,

> > you can be " reinstated " into medicare against your

> > will. The opt-out period is for 2 years, although

> I

> > think there is a brief window to withdraw the

> opt-out

> > in the beginning if you change your mind.

> >

> > Good luck!

> >

> > , MD

> > Rancho Mirage, CA

> >

> > --- roxywible wrote:

> >

> > > So I was curious if anyone has opted-out and how

> it

> > > is going?

> > >

> > > I plan to opt-out in October. I just missed the

> > > 7/1/6 date so I'll wait 3 months and it will

> > > give me some time to contact my medicare pts and

> see

> > > what they want to do (continue

> > > with me or not).

> > >

> > > It looks like (from reviewing all the data I

> > > collected on the listserv) that I send in an

> > > Affidavit that reviews the basic info (I have

> one

> > > from a Cigna site) and mail it to Medicare

> > > aleast 30 days prior to 10/1/6. I do not think

> there

> > > is an official " Medicare Opt-Out Form. "

> > >

> > > So for those who opted out what happened with

> your

> > > established patients? How many

> > > stayed? Was there a huge migration out of your

> > > practice?

> > >

> > > I plan to make it very affordable with a sliding

> > > scale - probably 40-60 bucks for most

> > > visits which is what our local Medicare pays for

> a

> > > 99213/214 around here anyway. People

> > > who are not financially strapped can pay my NL

> fees

> > > if they stay (with my usual 30%

> > > discount if they pay at time of service)

> > >

> > > Would love any pearls of wisdom before I jump

> off

> > > the ship. I would assume nobody had

> > > regrets and signed back on to Mediacre AFTER

> opting

> > > out. Has anyone done that??

> > >

> > > Thanks in advance,

> > >

> > > Pamela

> > >

> > > Pamela Wible, MD

> > > Family & Community Medicine, LLC

> > > 3575 st. #220

> > > Eugene, OR 97405

> > >

> > > roxywible@...

> > > www.idealmedicalpractice.org

> > >

> >

> > __________________________________________________

> >

July 7, 2006

I opted out and lost 80% of my small Medicare panel but it's great getting paid with the credit card same day on the others. I'd rather see Medicare patients for free (like one person on our listserve) than ever bill Medicare again. flores chris wrote: I don't want people to get the impression that mypractice caters to the rich and well-heeled.In my short experience (I'm only into my 8th month) Ihave noted that the biggest difference about being ina high income area is that my rent is higher than

mostof my colleagues in other parts of the country. "Lowoverhead" is a relative term, and I pay a premium forbeing in a high rent district. Interestingly enough -I have attracted patients from all areas of thisdesert valley, including low-income cities likeCoachella and Mecca, and modest communities likeDesert Hot Springs and Yucca Valley. I have Medicaidpatients in my practice, as well as uninsured folks(about 20-25% of my practice). Because I amSpanish-speaking, I attract working class Latinos -many of whom are in service industries like gardening,maintenance, housecleaning, etc. - some are probablyundocumented immigrants - not exactly high-incomefolks. I would guess that only 10-15% of my patientslive in Rancho Mirage.I do think that all else being equal, people wouldprefer to see a doctor in a nice part of town (or goto a restaurant in a nice part of town, or goshopping, etc). I was new to

this community and hadzero established patients, so I needed all the help Icould get to attract new patients. Besides, my wifeand I knew that building this practice we would be"living" here at the office, so we chose to set up ina nice area. My plan is that after I am established(hopefully within 2 years - we have an initial 2 yearlease with an option to extend for another 2 years), Iwill seek out cheaper digs (or buy an office condo soat least I am building equity), because my hunch(reinforced by this group) is that patients willfollow the practice because of the service, notlocation.The only "huge weight" I have felt due to my locationis on my bottom line, because of the high rent!I sincerely believe that a cash-only practice can workanywhere - my wife and I chose this location becauseof family reasons. In other areas, rent would be lessand office fees could be commensurately lower,

makingit affordable for most of the population.Rancho Mirage, CA--- drbrockrrohio wrote:> Opting out of Medicare, cash-only practices, etc> generally only work in affluent areas though. I was> curious, so I searched on "Rancho Mirage California"> in Google. The average household income there is> $89,000/year. That needs to be kept in mind by> others considering a similar practice style. You> have to keep in mind the huge weight that LOCATION> carries. In my community even people with private> insurance do not like to pay a second co-pay if I> send them for a referral. I'm not sure what the> average household income is here but it is certainly> not $89,000/year. > > > > > > From: flores chris <c_flores_md>> > Date: 2006/07/03 Mon PM 09:42:16 EDT> > To: > > Subject: Re: Medicare> OPT-OUT .... how's it going?> > > > I have been opted out since Jan 1st 2006. It is> going> > well for me in my community which is traditionally> a> > retirement area - lots of seniors and not enough> > primary care doctors for them. I thought my> opt-out> > status would have scared away a lot of Medicare> > patients, but quite the opposite has happened. > 40% of> > my patients are Medicare and they fully understand> > they cannot get reimbursed for my office fee - but> > they love the long appointments, in-depth>

discussion> > of their concerns, and the convenience and> > unobstructed access they have to me. I can do> house> > calls because I'm not trying to dance around> medical> > necessity rules and Medicare still covers most of> the> > labs, x-rays, referrals, etc. I order on patients.> > > > I am not looking back and I am enjoying medicine> more> > than ever. You do have to have each and every> patient> > sign some sort of "medicare private contract" with> you> > (we got our language from the website of the local> > medicare carrier), and you need to remember to> renew> > your opt-out affidavit every 2 years - you will> not be> > reminded and if you don't file it within the> deadline,> > you can be "reinstated" into medicare against your> > will. The opt-out period is

for 2 years, although> I> > think there is a brief window to withdraw the> opt-out> > in the beginning if you change your mind.> > > > Good luck!> > > > , MD> > Rancho Mirage, CA> > > > --- roxywible <roxywiblecomcast (DOT) net> wrote:> > > > > So I was curious if anyone has opted-out and how> it> > > is going?> > > > > > I plan to opt-out in October. I just missed the> > > 7/1/6 date so I'll wait 3 months and it will > > > give me some time to contact my medicare pts and> see> > > what they want to do (continue > > > with me or not).> > > > > > It looks like (from reviewing all the data I> > > collected on the listserv) that I send in an

> > > Affidavit that reviews the basic info (I have> one> > > from a Cigna site) and mail it to Medicare > > > aleast 30 days prior to 10/1/6. I do not think> there> > > is an official "Medicare Opt-Out Form."> > > > > > So for those who opted out what happened with> your> > > established patients? How many > > > stayed? Was there a huge migration out of your> > > practice? > > > > > > I plan to make it very affordable with a sliding> > > scale - probably 40-60 bucks for most > > > visits which is what our local Medicare pays for> a> > > 99213/214 around here anyway. People > > > who are not financially strapped can pay my NL> fees> > > if they stay (with my usual 30% > > > discount if they pay at time of service)>

> > > > > > > > Would love any pearls of wisdom before I jump> off> > > the ship. I would assume nobody had > > > regrets and signed back on to Mediacre AFTER> opting> > > out. Has anyone done that??> > > > > > > > > Thanks in advance,> > > > > > > > > Pamela> > > > > > Pamela Wible, MD> > > Family & Community Medicine, LLC> > > 3575 st. #220 > > > Eugene, OR 97405> > > > > > roxywiblecomcast (DOT) net> > > www.idealmedicalpractice.org> > > > > > > > > > > > > > > > > > > > > > > >

__________________________________________________> >

July 7, 2006