September 2, 2008

Dear Colleague,

Rumors float and fly and, like the fish that got away, tend to grow. As a few rumors seem to be circulating about my practice, I wanted to take the opportunity to write to set the record straight.

As of July 1, I have opted out of Medicare.  The combination of the more than 132,000 pages of regulations and the ongoing threats of cuts in reimbursement brought me to my personal breaking point. I grew tired of providing service above and beyond the average, saving the government and insurance companies gobs of money, and taking none of that home. At the same time I have been doing my best to comply with all of the regulations, but I know full well, that no matter how hard we all try, no physician can fully comply with all 132,000 pages. Opting out, by the way, is different from becoming a “non-par” physician.

Currently, 42 percent of all Texas physicians, and 62 percent of Texas primary care physicians limit the number of new Medicare patients in their practice. (TMA survey) By opting out, I don’t need to place any such limits on my practice.

In contrast to the physicians of The San Antonio Orthopaedic Group, both Dr. Garcia and I accept Blue Cross, Blue Shield. Also in contrast to their published opinion (Express News 8/19/08), we feel that Medicare patients are likely to need more care, than their younger counterparts, and certainly they deserve no less.

I am still happy to see Medicare patients. However, I now will see them on a fee for service basis. I won’t bill Medicare, and they can’t bill Medicare. We can bill and collect on the secondary insurances as an ongoing service to the patients. Many secondary insurance carriers will pick up a significant portion of the bills, some, the majority of the expense.

My opting out of Medicare concerns only me and my fees. Medicare will cover the hospitalization costs, and should cover all of the ancillary issues such as physical therapy or medications. My bill constitutes only about 5% of the total bill for a surgery. My office will work with all of the patients regarding payment plans. Further, in true cases of need, I am now allowed to provide discounted services without having to pass the same discount along to all patients in the practice.

My partner, Eddie A. Garcia, M.D. does accept Medicare, and remains directly involved in both standard Medicare and Medicare Advantage programs. In addition to his subspecialty of Sports Medicine, he treats many of the same conditions that I routinely treat, the only exception is that he does not perform total joint replacement surgery.

At the same time, this offers some opportunities for actual savings. For example, I have set my fees for total joint replacement, with the most modern techniques, at 80% of what I charged for the traditional techniques in 1990, when I first charged and collected for my own services. Other therapies, such as viscosupplementation, will be less expensive, as I can negotiate supply costs.

The bottom line here is that it is both my pleasure and Dr. Garcia’s pleasure to see Medicare patients.  We want to “make it work” for as many of your Medicare patients as possible, and, as always, it is a pleasure assisting in the care of your patients.

Sincerely,

Adam I. Harris, M.D.