Tag Archive for: Medicare

Dear Friends, Patients, and Family, 

I started in practice in San Francisco in 2009 and, at this point in my career, I have performed over 3,500 hip surgeries. For years I enjoyed what I believed to be the pinnacle of success in my practice. We were generating good revenue, I had hired an excellent staff, and I was treating complex cases and taking care of truly grateful patients. During this time, I developed protocols allowing me to provide a very high-quality service at a very low cost to Medicare and other Insurers. With insight into regional benchmarks we found ourselves at the top in a national marketplace for hip surgery. 

Over the past decade, we have seen Medicare revenues markedly decline for what I do. They stopped paying for value. The bonuses that helped pay for my overhead were diminished and/or withdrawn. This year (2022), coinciding with the CMS Final Rule, I finally went ‘upside down’ with Medicare. At this point I spend more money on my staff and support for each Medicare case I take on than the reimbursement I receive. I had to make a decision: either let the practice fold, sell, or continue on without Medicare. I could no longer ‘make it up on volume’ and continue to provide high-quality outcomes. 

I am not alone here. I am hearing this daily from my physician colleagues in the halls and doctors’ lounges. With inflation at 8% (or higher), rising cost of equipment and supplies, staffing shortages, and the already thin margins provided by Medicare being cut further, it seems that no one can make this work. Some surgeons have more runway, as they are employed by Kaiser, Sutter, UCSF, or Stanford. But all of us are going to feel the squeeze. Some of us, like those of us in private practice will be hurt financially early on. Those who will be required to see more patients to make their salary will feel burnout later. I see these as the first cracks in our broken healthcare system. 

Opting out of Medicare

 As of July 1, 2022, I will have “Opted Out” of the Medicare system. What this means is that while all other aspects of Hip Surgery, including, but not limited to; the medical facility, the medical staff, anesthesia, medications, durable medical equipment, and physical therapy, are still covered by Medicare, my fees are not. I have tried to keep these fees affordable to make access easy for our patients who elect to go “out of network” under my care.  My fee schedule is public and listed on my website and I will remain transparent about all billing.

Most Medicare patients can expect to get hip surgery in the range of approximately $6000-7000 dollars. The benefits of this new relationship to my Medicare patients are that I can continue to provide the highest level of care and be more available. I hope to have more time with each individual patient. I feel my best when I can take the time I need for each patient and don’t feel like I am behind all day long trying to make the numbers work on volume.

I expect that appointments within a week or two can usually be accommodated, and surgeries can be expedited for those eligible candidates. I realize this will leave a few patients in challenging positions. I am working hard with consultants to try to provide options for direct care of patients through our public charitable foundation, www.Hipsterfoundation.org. I hope to have more on this front in the coming months.  In the meantime, please contact the office with any questions you have.