Urologist who opted out: No regrets after 5 years

Traverse City, MI--Oct. 1, 2006, marks the fifth anniversary of the date on which Michael Harris, MD, opted out of Medicaid and Medicare and rid himself of all commercial insurers. He put his urology practice on a strict cash-for-services basis in 2001 and he has not looked back.

"This is how you practice medicine," Dr. Harris told Urology Times in a recent interview. "All the bureaucracy that is inflicted on a typical medical practice today contributes absolutely nothing to the care of the patient. All it does is hamper performance."

Dr. Harris anticipates the arrival of Oct. 1, 2007.

"That is the date on the affidavit. You have to opt out every 2 years; otherwise, you are automatically back in. One doctor I know compares it to a time-limited divorce," he explained with a chuckle.

October 2006 marks another milestone. By this date, Dr. Harris will exceed the 5-year statute of limitations created by the 140-year-old False Claims Act of 1865, which was updated in 1986 to increase penalties. This act allows government auditors to review charts.

"I will be beyond their reach," he said.

Four years ago, Dr. Harris was interviewed by Urology Times when he had been out from under insurance plans for only 1 year. We contacted him again recently to see how much his life and career have changed in the interim.

The changes he noted were those that affect most practices: Business goes up; it goes down.

He estimates that about two-thirds of his patients were Medicare recipients when he decided to become a non-participating provider at the close of 2000. Ten months later, in October, he opted out of the program altogether. Federal law allows practitioners to withdraw participation from Medicare annually on Dec. 31. Opting out can be done quarterly.

Repercussions of independence

When Dr. Harris opted out, he lost about half of his clinical volume overnight. He has been steadily rebuilding his patient base, but estimates his clinic is 20% under capacity. This is not altogether bad news, he claims. The reduced workload allows him to spend more time examining patients and educating them about their disease and therapeutic options.

As might be expected, Dr. Harris' income plummeted, but so, too, did his overhead. When he was accepting government and private health care insurance payments, he says overhead consumed 45% of his revenues. By opting out, Dr. Harris estimates that overhead dropped by about 75%.

He currently has two office employees: a receptionist who works Tuesday through Friday and a nurse who works 4 days per week, with Wednesdays off. He does little advertising. Sometimes he places a small, informative medical article in the local Sunday paper when business seems slow. The majority of his practice is dedicated to prostate cancer.

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