The Opt-Outs: Otolaryngologists extol the benefits of third-party independence

When describing to the curious the benefits of opting out of both Medicare and private insurance, Gerard J. Gianoli, MD, president of The Ear and Balance Institute in Baton Rouge, La., often recalls one particular example: During one 90-day global period about five years ago, after an eight-hour resection of a skull-based glomus tumor, post-operative ICU care and several days of inpatient care and the usual post-operative office visits, he received a total reimbursement of $500.

“I don’t even think that covered the malpractice portion of my premium on that case,” said Dr. Gianoli, clinical associate professor of pediatrics and otolaryngology–head and neck surgery at Tulane University School of Medicine and an ENT Today board member.

Dr. Gianoli’s case for “opting out” may be more persuasive than ever in the current landscape, as more and more physicians, otolaryngologists included, consider operating practices that accept no private insurance or Medicare, known more formally as third-party-free practices. The conversation has percolated in recent years, but the concept seems to have drawn even more attention in the wake of the health care reform debate, with physicians who accept insurance and Medicare fearing reduced reimbursements. To wit, the Association of American Physicians and Surgeons (AAPS), whose website includes how-to guides on opting out of managed-care contracts, has seen record numbers of online visitors in the past year. AAPS has also sold out two one-day seminars this year aimed at educating physicians on their opt-out options.

“When I first mentioned this to my colleagues, they said I was crazy and it wouldn’t work,” Dr. Gianoli said. “Now, many of those same people are asking me how they can do what I did … there is a growing tide of interest in what we are doing.  I am asked to lecture on the topic, and many physicians call or e-mail asking for details.”

Jane Orient, MD, executive director of the AAPS, believes the third-party-free concept will become even more appealing as the government and private carriers ramp up efforts to recoup money improperly paid out, an initiative driven by the Centers for Medicare and Medicaid Services’ Recovery Audit Contractor (RAC) program.

In that vein, otolaryngologists considering opening a third-party-free practice from scratch or transitioning their current practice may wonder if the swap works on a variety of levels. The resounding answer from those who have done it: with a few common sense tweaks to practice management, absolutely.