Dr. Carpenter said. “There’s a point where enough is enough. All that stuff was starting to get in the way of prac- ticing medicine and helping people.”
Pros vs. cons
Ms. Davis says opting out of the Medi- care program definitely can reduce pa- perwork and other administrative has- sles in a physician’s practice, as you no longer have to file Medicare claims for patients, comply with CMS regulations, or worry about Medicare audits. But she says opting out may not be a smart deci- sion for all physicians.
Physicians who have a large Medi-
care patient population might take a sig- nificant hit to their practice revenues if they pull out of the program and their patients go elsewhere, she says. It might be particularly difficult for rural physi- cians to opt out since they tend to have high numbers of Medicare patients who likely could not afford to pay out of their own pocket for care.
It also might not be feasible to opt out if you are in certain specialties that tend to see a lot of older patients, such as orthopedics, endocrinology, and on- cology, adds Joseph Gave, director of TMA’s Clinical Advocacy Department. Dr. Noyes says he had very few Medi-
care patients, so that was not a big consideration for him. “We’re in Frisco, Texas, and it’s a young, affluent suburb, so combined Medicare, Medicaid, and TRICARE were only about 3 percent of our income.” Dr. Carpenter, on the other hand, says about 25 percent of her patients were Medicare beneficiaries before she opted out. Fortunately, she also practices in an affluent area and many of her Medicare patients decided to stay with her and pay out of pocket for her services. Only about 20 percent of her Medi-
care patients decided to change physi- cians, she says.
Physicians who opt out also stand
to lose out on a number of Medicare incentive programs. The most lucrative of these is the electronic health record (EHR) incentive programs.
Physicians who achieve meaningful
use of an EHR system can receive up to $44,000 to offset the cost of that EHR
system. The first payments of $18,000 were made in 2011 with the remainder of the funds to be paid out in install- ments until 2015. Physicians who begin meeting the meaningful use require- ments this year still can receive the full $44,000 between now and 2016. Physi- cians who meet the requirement in 2013 are eligible to receive up to $39,000, and doctors who meet the requirement in 2014 can receive up to $24,000. But physicians who opt out of Medi-
care before receiving the full EHR incen- tive payments would lose any future payments, says Shannon Moore, TMA’s director of health information technol- ogy. For example, a physician who re- ceived the $18,000 initial payment in 2011 but opted out of Medicare this year would forfeit the remaining $26,000 in incentive payments.
The same is true of bonuses paid for
e-prescribing and reporting to the Medi- care Physician Quality Reporting System (PQRS). Medicare will pay a 0.5-percent bonus in 2012 and 2013 to physicians to report quality data to PQRS. In 2012, the Medicare e-prescribing initiative pays a bonus equal to 1 percent of all of a physician’s Medicare allowable charg- es; in 2013, the bonus is 0.5 percent. Ms. Moore says doctors who leave
Medicare are not eligible for any of those bonuses and still might find themselves having to comply with those programs down the road if they decide to opt back into Medicare in the future.
A business decision Dr. Carpenter says revenues in her prac- tice haven’t changed much as a result of her decision to opt out, but she has seen
TMA ADVANTAGE
Opt-out calculator tool available from TMA
Are you thinking of formally opting out of Medicare? If so, TMA has a tool that can help you determine the likely financial im- pact on your practice. The TMA Medicare Opt-out Calculator makes it easy to esti-
mate the likely change to your practice revenues if you drop out of Medicare entirely. The calculator asks the physician to plug in total annual revenues from Medicare patients, then estimates changes that would occur if the physician were to opt out of Medicare, including the percent of Medicare patients likely to stay with the practice paying cash, the percent of empty ap- pointment slots likely to be taken by commercially insured pa- tients, and the percent of vacated appointment slots that likely would remain empty. The calculator also allows physicians to gauge the impact of
potential fee cuts that could result from the Medicare Sustain- able Growth Rate formula. To get a copy of the Medicare Opt-out Calculator, log on to
www.texmed.org/medicare_opt_out_calculator.
July 2012 TEXAS MEDICINE 29
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