sent to all Medicare patients on September 30, 2016

To my patients:


I write to you to first say THANK YOU. It is a privilege to be your physician and I am always humbled that you have entrusted me with your health. It is my hope that in the 16 years that I have been given the opportunity to practice along the Gulf Coast that you have benefitted and are satisfied with the care I have provided.


I realize how fortunate I am that I have a job that I love and that I am able to practice medicine in an area where I can and have made a difference in people’s lives. It is my hope that I can continue to provide care to my patients without interference from any third party entity. The patient- physician relationship is sacred to me and any decision for treatment should be the result of mutual discussion and acknowledgement of two people – the patient and their doctor. My decision regarding quality care issues are driven by what I believe to be best for my patients and their individual needs.


Unfortunately, the reality that is in healthcare today is that the third party insurers, especially those funded by the federal government, continue to force themselves into the exam room. Doctors are being told that their options are either “you play by our rules” or face penalties.


In order to maintain the quality of care my patients deserve, I must avoid interference from any third party. Therefore, I will no longer contract with insurance companies who are coercing the independent physician – and that includes those insurances run by government entities.


What many people do not realize is that insurance company contracts are voluntary, and that includes federally funded insurers such as Medicare. I have filed an affidavit to “opt out” of Medicare. This means it was my choice to drop out of Medicare. This becomes effective January 1, 2017. This means my office will no longer receive any payments from Medicare. Additionally, all patients who are Medicare beneficiaries who choose to see me, will be asked to sign a federally mandated Private Contract in order to receive services by our office. We will not be able to file a claim nor will the patient be able to submit one for reimbursement.


For those who are Medicare beneficiaries, there are attachments accompanying this letter that explain my rationale for having made this decision and what options you will want to consider. Please feel free to contact my office if you have any questions or if we can assist you in the transition of your care.


I have watched the delivery of healthcare change. I am a second generation physician in Pensacola, Florida and have carried on the lessons taught by my parents that you treat patients like your family – don’t worry about how it’s going to get paid, you concentrate on doing what is best for your patient! Many patients have asked “Can your practice survive?” Honestly, I don't know, but I trust the free market. I do know that I have thoughtfully and conscientiously made this decision based on what I believe to be ethically sound, truthful, and honest – particularly in light of the negative impact so many insurance practices have had on the practice of medicine. I am comfortable with my decision because in the end, the way that I examine, evaluate and treat my patients will not be influenced or restricted by a non-medical entity who does not put the patient’s needs first. I took that Hippocratic Oath, and I know who I am working for – it’s not any insurance company – but my patients!



Dr. Grace



The clinical side of the medical practice is the part that most patients are well-aware of because this is the side that is seen during the office visit as examinations are completed, treatments rendered, medications prescribed, referrals made and surgeries performed. This is the side that you know about, and the part that is most important to both of us. Unfortunately, that is only the half of the reality of today’s medical practice. The other half is that of regulatory burden imposed by Medicare in order to provide that medical care.
In 2017, the rules change once again for physicians as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) goes into full effect, with a complete paradigm shift in Medicare payment from fee-for-service to value-based payment. In essence, your doctor will submit a bill but only will get paid if Medicare thinks that they have done a good enough job. The question is “good enough job” according to whom?
Additionally, all doctors that care for Medicare patients in 2017 and beyond will have to make a choice. The first option is to join an accountable care organization (ACO), which is a large group that acts like an HMO to control costs and accept financial risk. The second option is to enter into a Merit-Based Incentive Payment System (MIPS), in which payment will be determined by where the doctor ranks on a physician scorecard. However, the “pot of money” for reimbursements remains constant – so even if every doctor makes an ‘A’ grade, half of them will be paid less money, just by nature of this “budget-neutral” payment system. This turns the free market on its head. Rather than a doctor’s reimbursement being based on necessary services paid at a fair price, it is contingent on a governmental budget process. What matters is not whether the service is necessary or performed well, but the intricacies of the federal budget. There is a huge potential for patients to suffer if doctors cut back on tests and treatments, but also for the physician to face malpractice lawsuits. The new Medicare law offers inadequate liability protection for doctors who are being required to keep medical expenses down simply to get paid for their work.
Up to this point, I have managed to play by the rules that Medicare has set. As with all my colleagues, I have had to spend hours of additional work on documentation, upgrade equipment and employ additional staff to help me comply with the new rules. Additionally, I have taken a penalty this year on Medicare reimbursements because of my decision last year not to invest in new electronic health records software system. This system offers patient portals but charges up to 7% of our business revenue annually just to fulfill the technological requirements for the second phase of Medicare’s Meaningful Use. In my opinion, that is an intrusion into my business. Medicare forced me to take a pay cut because I would not purchase what was, in my judgment, an overpriced software system that added no value to my business or the clinical care that I provide to my patients. In addition, Medicare’s constantly evolving and increasingly demanding rules mean I have to devote more and more of my time meeting their require than seeing patients. Up to this point, I have been able to absorb the increased expenses and decrease in payment, and I have been able to continue to care for my Medicare patients. However, as a private, independent, physician-owned medical practice, I can no longer meet their demands and still maintain a viable small business.

I want to remind you that I am not abandoning you; I am abandoning your insurance company.

This does not affect your Medicare coverage in any way and does not mean you will be restricted in using your Medicare benefits for any other physician or in in any labs, test or referrals that are ordered. I will still be able to help coordinate your care. Labs, diagnostic tests, durable medical equipment (including diabetic shoes and inlays), home health care and physical therapy ordered by me can be filed to Medicare by the vendor you are receiving the service from. It only applies to any physician services that I perform in my office and in the hospitals.
It is your decision to continue care with me or seek another doctor with whom you can use your Medicare benefits. I understand this is a financial decision you must make, and please understand that this is a business decision that I make in order to continue practicing medicine. I know there will be some who will be unhappy with this plan. I have no problems to help those patients coordinate transfer of their records to the physician of their choice and will prepare a summary to maintain continuity of care.

For those who choose to stay with our practice – Thank You! Enclosed in today’s letter is a sample of the form that the federal government mandates and requires that I have each Medicare beneficiary sign as an understanding that Medicare will not be reimbursing them anything whatsoever for any treatment and services rendered in my care. We will be requesting payment at the time of your visit and prior to seeing you will be more than happy to review with you our fee schedule and cash price based on the services to be provided. Many of you are familiar with this as we have practiced this currently with non-covered services that you have had to pay for up front.