A neurosurgeon is challenging new state rules to make hospitals report how surgeons use antibiotics to prevent infections

“The rules are meant to make patients safer, but McKalip argues they do just the opposite.

‘I don’t want the state telling patients what kind of medical care they can get,’ he said. ‘They’re not practicing medicine. They don’t have to face that patient.’”

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  • Anonymous

    He’s a typical doctor–how dare anyone ever question my competence in the slightest, ever. The government simply wants information and explanation. Given that it pays for over a majority of service, the gov’s probably entitled. Given that doctors claim what they do has something to do with science–yet practices vary incredibly by area and local culture, they should be eager for best practices.

  • Michael Rack, MD

    “The government simply wants information and explanation. Given that it pays for over a majority of service, the gov’s probably entitled”
    -
    It’s attitudes like this that make many doctors not want to see Medicare and Medicaid patients.

  • Anonymous

    Ah, Dr. Rack–so you don’t like dealing with a client so big and so powerful, it can place conditions on your service? Well, no one’s forcing you take medicare patients. Further, most of us have to acquiesce to our clients’ demands–remember, the customer’s always right, etc. Why are doctors so special?

  • Michael Rack, MD

    I work for the state of Mississippi. I see plenty of Medicare and Medicaid patients. I put up with state and federal control because of the steady paycheck and because I wanted to give academic medicine a try. Most physicians accept Medicare and some Medicaid because of a sense of social obligation and because Medicare currently pays ok. With decreasing Medicare reimbursement expected in the future, the number of physicians leaving Medicare will increase. Physicians have an obligation to society to provide some charity care, but not to put up with all of the bureaucratic nonsense that comes with Medicaid patients (prior authorization forms, constantly changing formularies) and the Federal regulation that comes with Medicare. When I go into private practice, I will provide some charity care. I probably will not see many Medicaid patients. Whether or not to participate in Medicare will be a purely economic decision.

  • Curious JD

    “Whether or not to participate in Medicare will be a purely economic decision.”

    Wasn’t it always?

  • Michael Rack, MD

    Curious JD,

    In addition to economic reasons, many physicians participate in Medicare out of a sense of SOCIAL OBLIGATION. I personally feel no obligation to participate in Medicare and risk going to jail if the Feds don’t like the way I code a claim. As a state employee, I have to participate in Medicare. In several years, when I go into private practice, I will make an economic analysis, look at the payor mix of the area, and see if the $$ from Medicare outweighs the government regulation.

  • Curious JD

    I don’t doubt that many do, just as some attorneys work at the Public Defender’s office, or take some pro-bono cases out of social obligation.

    But at the end of the day, for the vast majority of us, we still have to eat and feed our families, so that determination comes FIRST. If we can do the other, that’s great, but it is a tiny percentage of people that doesn’t look at the economics first.

  • Michael Rack, MD

    Curious JD,

    I agree with your last post

  • Anonymous

    The issue in question has nothing to do with Medicare…….not that I disagree with your opinion of the system.

    It sure looks like a state issue, and would apply if you operated in any hospital in that state, regardless of participation status.

    Remember a couple of things if you go into private practice vis-a-vis Medicare. In for a penny, in for a pound. If you participate, you are subject to their rules, even if you see one Medicare recipient. Limiting your Medicare does not limit your exposure to Medicare rules. It’s all or none.

    If you choose to “opt out” of Medicare, remember that, courtesy of Medicare rules, you have to re-”opt-out” every couple years – check the Medicare web site for the exact rules. Otherwise, you may find yourself unilaterally put back in Medicare.

    Sort of like getting divorced and finding out two years later, you’re married again.