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One Urologist Reaches His Breaking Point; Are You Next?

September 12, 2002
By: William F. Gee, MD
Urology Times

An astounding article in this issue of Urology Times details how one urologist quit all commercial insurance participation, then "opted out" of Medicare-and is not only surviving, but thriving (see Urologist's bold move takes him off Medicare's radar).

Mike Harris, MD, a well-trained, board-certified, respected urologist in Traverse City, MI, said "Enough is enough!" and did something about it. He no longer exists in any private insurance carrier database and likewise does not appear anywhere on the Medicare radar screen.

What is the impact on his practice? Suddenly no threat of Medicare audits; he's immune. No HIPAA compliance problems to be concerned with; he only takes cash and therefore does not transmit private health information. No CPT or ICD-9 codes to worry about. He just practices urology, and his patients pay cash-up front.

The concept is not new. It used to be that way before the advent of Medicare and private insurance. Cosmetic plastic surgeons have run their practices this way for years. And, Dr. Harris is not only earning a living, but a good one. He has fewer patients but lower overhead and more time for family, clinical research, and recreation.

His income is down some, but his lifestyle and peace of mind are up, way up. Follow-up patients come to see him less often, and more appropriately, as they are now paying for their care and look after their own health care dollars.

There is a down side. Other urologists in the community have a greater burden of Medicare patients. Established patients who do not have the financial means to pay for their own care were forced to find a new urologist. And Dr. Harris does take home a smaller paycheck.

Not one of the government oversight programs foisted on physicians in the past 15 years-OSHA, CLIA, HIPAA, EMTALA, or Medicare audits of E&M codes-has ever been shown to result in improved patient care. Until now, most of the physicians who opted out of Medicare have been psychiatrists, family practitioners, and internists. But, is the flood gate about to open? What is your breaking point? Will you be next?