“Is There Care Without Medicare?” Asks Association of American Physicians and Surgeons


Tucson, Ariz. In 1966, the government was afraid that a lot of self-reliant, freedom-loving Americans would refuse to participate in a government medical plan. So President Lyndon Johnson forced insurers to cancel the private plans that enrolled about half of America’s senior citizens. There was no talk of a “public option competing on a level playing field.”

To entice doctors, the government enrolled them automatically, and made it very easy and profitable to participate: no more problems trying to collect from patients who didn’t have money, or who preferred to use their money for other things.

Now that Medicare is broke, the government is making it much more difficult: enrollment and periodic re-enrollment or “validation” forms, constant rule changes, costly compliance requirements, and in some cases criminal background checks, finger-printing, even moratoria on issuing provider numbers. Payment rates in some cases are so low that they don’t even cover the cost of providing care.

New patients who call a doctor’s office are often finding that there are no appointments available for Medicare beneficiaries. Those who do get in may discover what happens when doctors are “incentivized” to provide less care.

Doctors are now asking: “What happens if I disenroll http://www.jpands.org/vol16no4/orient.pdf and try to contract privately with patients http://www.jpands.org/vol16no4/schlafly.pdf instead?” This question is considered in two articles in the winter issue of the Journal of American Physicians and Surgeons, the official journal of the Association of American Physicians and Surgeons.

More and more physicians are “opting out,” a process that requires them to have every patient sign a contract agreeing that there will be no Medicare payment for the opted-out physician’s services for two years.
Disenrollment looks even more attractive to physicians: no more remembering to “re-opt out” every two years, no more piles of government-approved contracts to keep on file. Even better, their patients may still be able to receive their Medicare benefits, by filing a very simple form, CMS form 1490S.

Medicare and its private carriers have long tried to give the impression that physicians who don’t “take” Medicare or file Medicare claims cannot legally treat any patients who are enrolled in Medicare Part B.

“As far as we can determine, there is no law expressly forbidding Americans to spend their own money for life-saving medical treatment if they sign up for Medicare Part B,” states Jane M. Orient, M.D., executive director of AAPS.

Disenrollment is a way to evict occupiers from doctors’ offices and the patient-physician relationship, she suggested. Occupiers include bureaucrats, bounty-hunting auditors, federal prosecutors waiting for doctors to trip up on complex rules—and AMA officials and committees who make up complicated codes and dictate the “relative value” of all covered services.

“The federal government has increasingly influenced and controlled medical practice by placing conditions on the Medicare program,” writes AAPS general counsel Andrew Schlafly. But will it risk a constitutional challenge to its power by trying to interfere with the purchase of care outside the system?

AAPS, a national organization representing physicians in all specialties, (www.aapsonline.org) was founded in 1943 to defend the sanctity of the patient-physician relationship.

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