PP: Is any of it salvageable in your eyes?
Girgis: I think [CMS] is going about it the wrong way. I think patients need quality medication, but they are serving their political agendas, rather than have it be about clinical outcomes. They said they are making it patient-centric, but that's not true. They have it so people are focused on the data, rather than the patients. The metrics [look at patients as data points]… there are patients who are sick with multiple diseases [that won't be looked at positively in terms of data analysis] but you can improve their health. Under this incentive system, you get penalized for spending a lot of time with those patients who are never going to get better.
Bradley writes: The only way for doctors to have real power and influence is to unite and form a union. This is the only way that doctors can impact the rules and regulations that affect their financial future and the way they care for patients. Individual doctors have zero power, zero voice in influencing those that make regulatory decisions. In the inevitable future when we do have a single payer, universal healthcare system, a unionized physician entity will be the only way to powerfully represent physician interests. … Multibillion dollar insurance companies are, of course, interested in one thing, their profits. They maximize this by paying physicians as little as possible for their professional medical care and by denying care to patients. They deny care through ever increasing monthly premiums which employers then pass on a portion to the employee, they deny care by yearly increasing the deductibles so patients simply don't go to the doctor until problems are advanced, and they deny care by denying diagnostic tests, and newer, more effective medications. …
Dominick says: The time has come to disenroll from Medicare. Many physicians do not understand that the patient can submit the claims with form 1490S or physicians can submit this form on behalf of the patient. The patient receives the check and forwards you payment.
Benefits of disenrolling:
1) You are no longer subject to Medicare guidelines, mandates, and edicts.
2) The office staff overhead goes down significantly
3) You are back in a contractual legal arena. You have six years to collect from your patient, not one.
4) You can send your patient to collections and sue them in court for payment if necessary and get a judgment.
4) The threat of audits go away.
5) Payment reduction goes away.
6) MACRA goes away.
7) You will see increased reimbursement.
Will your patients go away? Probably not. The Medicare generation is still used to paying for medical care. The majority will forward payment to you. The few that don't you can send to collections just like your other patients. It is time to take back this profession. Patients have a right to the standard of care wherever they may seek to be treated. They do not have a right to free care.