I have made a personal decision as of July 4th to terminate all of my contracts with Medicare and managed care companies as soon as the contracts allow. I think of this as my own personal independence day.

This has been a long time coming, but I can no longer bear the shackles of government and insurance company rules, the burdens of their regulations and the fear of their retributions for the paltry reward of their monetary compensation for my services.

I will tell my patients that I have left their insurance plan in order to work solely for them. I will pledge to continue to give them the very best care that I can. I will tell them that I can no longer work with the third-party payer in the exam room with us. I hope that my patients value the services that I provide. For many of my patients, the cost of their co-payments makes up a large part of what I am paid for the visit.

What brings me to this difficult choice?  The failure of the government to permanently fix the long-promised physician reimbursement rate factored greatly into this decision. I am concerned for the welfare of our Medicare population and the Tricare patients—our military, their families and their dependents. The cuts to Medicare payments will create an access nightmare that is only going to worsen as the population ages and more and more baby boomers enter the system. The failure of Congress to take responsibility and finally fix the basic Medicare reimbursement formula, a problem that they created, is unconscionable.  If the government is unable to manage Medicare, how are they going to manage the entire health system?

I have been in the solo private practice of dermatology for 25 years. I have tried to practice with the total focus on my patients, but this has become impossible. My staff and I spend an exorbitant amount of time dealing with claim denials, insurance managers, pre-authorization managers and pharmacy benefit managers. There is so much health system managing that there is little time for health care.

I’m taking this step into the unknown not knowing if my patients will leave my care in order to stay in their “plan.” I can only hope that they value the services I give as much as they value other goods and services that they purchase, such as cable, internet service, restaurant meals, ball games and movie tickets.

Many of my patients cannot afford to go “out of plan” and privately pay. Many do not have insurance and many cannot afford to pay for care at all. This has been so since the dawn of the profession and yet physicians have never turned those patients away. The current health care system is not paying for itself, and it is only maintained by the generosity and charity of physicians. The average patient does not realize how much uncompensated care physicians provide, yet physicians continue to provide care simply because that is what physicians have always done. I am hopeful that I can generate enough income to pay for the actual operation of my office, so that I can continue to give services to the needy.

This is my own personal decision. I am not suggesting or advocating that anyone else take this step, and I realize that many physicians are unable to declare independence from the third-party payer system. In many ways, it takes more courage and bravery to stay in the system and fight to change it. Rest assured that in spite of my personal decision, I will continue to fight for the rights of physicians and the sanctity of the doctor-patient relationship, which is the core of the practice of medicine.

 

Leah McCormack, MD
Middletown, NJ

Dr. McCrmack is president of the Medical Society of the State of New York