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Following a long period of deliberate
contemplation, we, the physicians of Lake Washington Sports & Spine, have
decided to cancel our contract with the Center for Medicare Services
(CMS). This will take effect as of April 1, 2015.
As board-certified Sports Medicine
providers, with the primary mission of keeping people active (KPA!), we cannot
in good faith continue this relationship as our mission no longer appears to
align with that of CMS.
To clarify, this means that Drs. Hyman
and Chimes will no longer process Medicare insurance claims in our office as of
April 1, 2015.
We'd like to explain our decision, at
least in brief.
The Medicare trust account is
underfunded. This is well established. The fund is expected now to
be depleted by ~2030. Over a period of years, CMS has set in process
several measures to reduce healthcare payments to providers caring for Medicare
beneficiaries, or to eliminate coverage altogether for some effective and
well-established services.
For example, one spinal injection called
a therapeutic cervical facet joint injection is no longer covered, despite its
effectiveness for many patients. Other procedures that show promise such
as prolotherapy and platelet-rich plasma (PRP) injections for refractory
chronic tendon and joint problems are not covered, while CMS continues to cover
steroid ("Cortisone") injections even in light of very limited
evidence to support them. These policies make no sense, not for sports
medicine providers, nor sports medicine patients.
Despite the many additional years of
highly specialized training required to perform nerve testing, spinal
injections and musculoskeletal ultrasound (above and beyond that necessary for
our Board certification), CMS is reducing reimbursements for these services in
dramatic fashion: nerve testing has been cut by >50%, >60% in cuts
for certain cervical spinal injections and 2015 will bring cuts of nearly 75%
on ultrasound guided injections. In the
past, physicians have absorbed the small incremental cuts in payment, but, because
these cuts are so dramatic, the payments now in many cases are insufficient to cover the cost of doing
business.
New similar policies are set in place
each year. These global policies are most certainly designed to limit
access to care, deliberately to reduce costs.
Our primary goal is to provide the
absolute best care for patients who choose to seek our professional advice, and
to restore those patients to optimal function using the best possible tools at our disposal.
And so therein lies the conflict.
We are focused on caring for and improving the health and wellbeing of
our patients and our community. CMS's
goal is to reduce healthcare dollar spending in the United States.
Additionally, Medicare has been hiring
bounty hunters called RAC's to review charts to look for errors in coding (and
medical coding is unnecessarily complex) to charge physicians with fraud, and
fine hundreds of thousands of dollars or in some cases send physicians to
federal prison. So not only is CMS reducing our reimbursement, but it is
placing physicians’ billing practices under a microscope, looking to recoup
millions of dollars and to criminalize and make examples of physicians.
While we are certain that our clinic's practices would hold up to the
greatest scrutiny, we would rather not continue on this booby-trapped playing
field.
We are confident that this decision will
positively influence our patients, and will more than ever, align patient and
physician goals. We recognize that our decision may cause anxiety or
angst for some of you. Should one wish to continue to treat in our clinic
on a 'cash pay' basis, yet have concerns about ability to pay, we ask that they
please contact us to discuss these concerns. We will do everything possible
to ensure patients receive the care they need.
For additional reading, please refer to :
http://lakewass.blogspot.com/2015/03/ceasing-medicare-contract-frequently.html
http://lakewass.blogspot.com/2015/03/ceasing-medicare-contract-frequently.html
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