Ceasing Medicare Contract: Frequently Asked Questions

What Underpins Our Decision?

Our decision to stop contracting with CMS is based upon the simple premise that we wish to provide the best, unfettered, unobstructed care.  Care influenced only by what will best serve the patient.  We feel that CMS (and to a lesser extent, other insurers) continue to evolve and create policy with the goal being cost control, at times under the guise of improving quality.  

A very significant, though secondary reason, for discontinuing our contract with CMS is that the finances do not make sense.  Cuts in payments in many cases mean that our business liabilities exceed our reimbursements.  Our business certainly cannot sustain this trend of increasing costs and diminishing returns.  We aim to take control of and stabilize our financial circumstances, so we may continue to serve the sports medicine needs of the Eastside and greater Seattle community for many years to come.

What Does the Evidence Say?

It is a misnomer that scientific data, or "Evidence-Based Medicine" (EBM), is always available to guide us, the medical providers.  Even in the best of circumstances, when well-designed research studies are available to guide us, this is "evidence-informed medicine" -- meaning that one has to carefully interpret the research and apply deliberately as appropriate to the unique circumstances of an individual patient.  Moreover, CMS has manipulated the interpretation of data, selectively favoring research that restricts access for patients and conveniently disregarding research that favors promising techniques.  As cutting edge clinicians, this limits our toolbox for helping patients.

What Can You Do?

We would advise you to learn more about the evolving changes in healthcare and the risks posed to you as the healthcare consumer.  Then write your local, state, and federal representatives to express your opinions.  This impacts you, now, and your children and grandchildren in the future.

We also advise that when it comes to money and health that you budget for total health cost, which includes health insurance premiums, ancillary health insurance payments (copays, deductible, co-insurance), gym membership, and food.  Many patients only consider health insurance premiums and are caught off-guard by these other predictable expenses.

Can You Still Receive Medical Care from Us?

Yes.  Though you would have to sign some official paperwork consenting to receive treatment from a non-contracted Medicare provider, we would be happy to treat you in so long as we are the best fit to assist you.  We accept cash for our professional services.  Our goal is to restore you to optimal function as quickly as possible.

What if I'm Referred to Another Provider?  Can I Use My Insurance?

It depends.  If the provider to whom you are referred is a contracted provider through Medicare/CMS, then you may use your insurance.