Rebekah Bernard, MD, who wrote a book titled How to Be a Rock Star Doctor: The Complete Guide to Taking Back Control of Your Life and Your Profession, has written an open letter to her Medicare patients. Here are the choice bits:
For every office visit that we spend together, I spend at least as much time on what Medicare deems as necessary documentation, especially a new program called meaningful use.
To comply with Medicare requirements, I’ve had to spend thousands of dollars and massive amounts of time instituting electronic health records, adapting my practice to conform to the computer technology that wasn’t created to help me, your physician.
And next year the whole ballgame changes for physicians as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) goes into full effect, with a complete paradigm shift in Medicare payment from “fee-for-service” (I send a bill for your medical care, Medicare pays me), to “value-based payment” (I submit a bill, and I get paid if Medicare thinks that I’ve done a good enough job).
The kicker is that the pot of money remains constant – so even if every doctor makes an ‘A’ grade, half of them will be paid less money, just by nature of this “budget-neutral” payment system.
Up to this point, I have managed to play by the rules that Medicare has set.
In 2017, this may no longer be the case.
As a policy analyst, not a physician, I have to report a mixed response to this letter. I have great sympathy for the message: It hits two policy issues that NCPA has addressed forcefully: So-called Meaningful Use of Electronic Health Records (EHRs) and the fundamental reforms to physician payment in this yeare’s “doc fix” legislation, MACRA.
Meaningful Use of EHRs refers to the $30 billion of taxpayers’ money that was flushed away on EHRs that are (at best) ineffective at improving the quality of care. Rebellion against the program has increased since the money was paid out, and it should be abandoned.
MACRA was a disgracefully bipartisan bill that was rushed through Congress by physicians’ professional societies, which effectively sold out their members in order to increase the societies’ power over payments. Practicing physicians had no time to organize themselves to respond. It is good to see them finally pay attention.
On the other hand, physicians cannot just complain about how little Medicare pays them. Medicare is in a fiscal crisis and doctors who think they can go back to a time where their claims were just processed without question have unrealistic expectations. Unless and until they accept that giving Medicare patients power over medical prices and payments is the only way to reduce government bureaucracy, their Medicare problems will get worse.
Further, the threat to quit Medicare next year is one which I have heard physicians make for about 15 years. Although more physicians have recently dropped out, the number of physicians treating Medicare patients is growing in line with the number of Medicare beneficiaries, according to a recent report by the Medicare Payment Advisory Commission (MedPAC, see page 80).
In other words, the signal to noise ratio for physicians’ frustration with Medicare is very low. Until that changes, we can expect government to continue stumbling and bumbling around the program.
Dr.Bernard is certified with the National Board of Physicians and Surgeons
Saying no to insurance: Some area physicians giving direct primary care a shot
Liz Freeman, , 239-263-47789:58 a.m. EDT July 12, 2016
Dr. Rebekah Bernard has worked for a nonprofit clinic in Immokalee, a physician group affiliated with a hospital chain, and had her own practice within an urgent care center.Now she has a solo direct primary care practice south of Fort Myers and not far from Estero.
She wants simple, low overhead and no red tape. That way, patients pay a low monthly fee of $35 to $75, depending on their age, to be a part of her practice, she said.She opened Gulf Coast Direct Primary Care on July 5 and is enrolling patients."It's really, really ideal for people with high deductible (plans) or no insurance," she said.
Bernard, 42, has been thinking about going into this type of practice for several years. She recognizes there is risk with this type of practice but said it is worth it."I want to take back control. I want to be my own boss," she said. "I'm really interested in helping working people."
The tipping point for her is a new system of merit-based incentive payments to doctors under Medicare that will start 2019 but the federal government will start using performance scoring in 2017 for determining reimbursement, according to the American Medical Association.The new payment system will force many solo or small-group doctors into bigger groups, among other things, she said."It put into law 900-plus pages (of rules) for physicians to follow," Bernard said.
Direct primary care is a form of retainer-based practices which many physicians are turning to out of frustration with insurance regulations, issues with electronic medical records and high overhead.There is no uniform model of a direct primary care practice but doctors typically do not accept insurance. Bernard will not be accepting insurance and will not be participating in Medicare.Still, she recommends her patients have a catastrophic insurance plan or high deductible plan when a hospitalization is necessary.
Dottie Sugarman, of Bonita Springs, first became a patient of Bernard's 10 years ago when she was part of Physicians Regional Medical Group, affiliated with Physicians Regional Healthcare System in Collier County.She has no qualms about paying the $75 a month to be in the doctor's new practice, the 63-year-old said."She's likable, very personal and very computer literate," Sugarman said. "She doesn't make you feel like she's in a hurry to leave the room."
ugarman is retired and her health care coverage is Florida Blue through the Affordable Care Act. Her deductible is $6,700 a year and she pays roughly $1,000 a month in a premium because she doesn't qualify for a subsidy.She intends to submit paperwork to her insurer every time she sees Bernard to have it count toward her deductible, even though she figures she will never reach her deductible."I'm a healthy woman," she said. "I figured why not spend the money with her?"She expects to see Bernard twice a year, for wellness checks, blood work and the like."She will just make sure I'm in good shape," she said.
Patients are not required to sign a contract to be a part of her practice and instead pay monthly, Bernard said.A direct primary care physician typically need 600 patients, but she figures her break even is 100 patients due to minimal overhead with rental space and one employee. She's arranged for discount contracts with a laboratory and radiology practice for imaging, plus she's buying supplies through online retailers.In her previous practice within the Estero Urgent Care Center, she had 3,000 patients.
Eighty percent or more of what patients need to primary care services can be managed in the office, and blood samples can be drawn in the office and sent to the laboratory for the analysis, she said.
For more information about Gulf Coast Direct Primary Care, located at 17595 U.S. 41 South, Suite 227, call 239-322-3860.