Readers Respond

Medicare rules hurt small practices

I have recently written a letter to Dr. Shantanu Agrawal, the director of program integrity for the Center for Medicare and Medicaid Services to protest the unfair rules for reimbursement by CMS that come into play by January 2017.

I am a board certified internist working in Catonsville not far from CMS headquarters on Security Boulevard. I am a solo practitioner and have been so for the last 20 years. I have no other clinical staff and serve a retirement community with elderly Medicare beneficiaries. I also serve intellectually disabled patients and work with agencies that serve this population. Almost all of these patients are Medicare and Medicaid beneficiaries.


Having said that, I still do not qualify as a small practice under the Medicare Access and CHIP Reauthorization Act of 2015. I am already paying penalties under the current fee-for-service model — by not participating in "meaningful use" stage 2, my payments are reduced by about 4 percent. This program has since been scrapped, but my payment reductions continue.

As I see it, I will be further penalized for participating in the Medicare program and accept assignment.


I have had no communication from CMS as to what codes I have to use in order to avoid further penalties. My understanding is that by incorporating certain codes in CMS 1500 claims, I can avoid the penalties, but shoulder the administrative burden.

Medicare is my biggest payer and has been for many years. After all, CMS is by far the largest insurer in this country. I stand to lose a significant portion of my income come beginning in January. If I chose to drop Medicare, I will still lose income and patients and face a significant administrative burden.

In my opinion, these new physician reimbursement models that target Medicare cost cutting are misdirected. CMS needs to look more closely at hospital, drug and pharmaceutical benefits and durable medical equipment reimbursements with their overblown costs and can reap exponentially greater savings in those areas.

So I sit on the horns of dilemma: Keep Medicare and get squeezed even more or drop Medicare and get crushed. I believe it behooves the director of this program to hear me and the voices of thousands of other practitioners and find some other ways for CMS to save health care expenditures.

Dr. Ramana Gopalan, Catonsville