“I’ll retire,” says Paul G. Rochmis, MD, a northern Virginia rheumatologist who admits he’s nearing the end of his medical career. “This is the straw that breaks the camel’s back. The problems dealing with Medicare have become so onerous that this will make the decision much easier.” Dr. Rochmis says he closed his practice to new Medicare patients last January because he refused to lessen the amount of quality patient time.
If the payment cuts go through, rheumatologists who currently accept Medicare assignment have three contractual options.
In Long Island, N.Y., Max Hamburger, MD, managing partner of an eight-person private rheumatology practice, says 45% of his patients are in Medicare. “As a first step, we would immediately cease accepting any new Medicare patients,” he says. “We don’t have an answer yet to what we’d do with our current Medicare patients. But, we’d have to downsize the practice, let go of perhaps 20–25% of our staff, and consider one or two junior physicians.
“It becomes a question of the cost of living and whether our practice can remain viable if there is a large percentage of Medicare patients,” he continues. “This is especially true for those of us in areas where Medicare is our best payer. In other parts of the country, that isn’t the case.”
Michael Schweitz, MD, says his seven-person practice in West Palm Beach, Fla., is about 60% Medicare patients. “If cuts go through, we’ve decided we will stop seeing new Medicare patients at first and then may restrict slots for existing patients. Ultimately, we may stop altogether or opt out,” he says.
Even with the cuts, Washington, D.C. rheumatologist Herbert S.B. Baraf, MD, says his practice will most likely continue to participate in Medicare so that young doctors who’ve joined the group can fill their patient appointment slots.
Dr. Baraf’s group has wrestled with their decision, especially as they sought to better understand the economic impact if they moved to nonparticipatory status. “The 15% surcharge (limiting charge) that you can place is on 95% of the physician fee schedule amount,” he says. “So, the most the physician can see by going ‘non par’ is 109.25%, but it is likely that we would accept assignment at the reduced rate on many claims. I don’t believe the reason to go ‘non par’ is to make more money. I believe it is to make your practice less attractive to Medicare beneficiaries if your commercial plans pay for services at rates above Medicare.” An additional concern is the risk of bad debt on unassigned claims if you don’t collect up front, he says.