I have no comments on the "profit center." However, if the 30% medicare cut goes into effect, there will be many things I do that will become gauranteed losses.
I find this current discussion very interesting. I have thought about the fact that it may eventually become challenging to pay for a new OCT machine when the rates fell this year. Such a trend will lead to lower quality care as Visionary points out above.
Our technology available today is unreal. The best care (no costs spared) has been available to all in this country. However, we are currently at a tipping point in healthcare - the problem is there is not enough money available to give the best quality care to all. When the real cuts come (and they will as our country cannot spend 100% of GDP on healthcare), quality of care will suffer.
In other words, just like the children of today will have a lower standard of living compared to the baby boomers, medicare recipients of tomorrow will have a lower standard of care compared to today's medicare recipients.
If the 30% cut goes into effect, Medicare Part B will be done. Anyone with brain tissue can figure that out. Primary care, which is already on the ropes in many parts of the country with Medicare will probably lead the way, and that is likely all that it will take to collapse the program. Even a large minority of primary care doctors closing to new Medicare patients while a smaller number opting out will be all that it will take to upend the Part B program.
Right now, opting out is a threatening process. It requires forgoing all participation with Medicare for two years thereafter. When many doctors participate, opting out carries the possibility that all your patients will go to other doctors who do participate. So few opt out. For now.
But if you slap a 30% cut on payments (remember, that is this coming year; there is yet another big cut coming the next year under the infernal SGR,) you have made Medicare an outright across-the-board losing proposition: surefire business failure. The decision becomes very clear and easy then: drop Medicare, drastically re-structure your practice business to reduce overhead, and the easiest thing to cut is the whole billing-coding-collection apparatus that doctors have had to adopt to use Medicare. But to do that, it makes no sense to have contracts with private carriers either, since that same apparatus is necessary to file and collect with private insurance. What will result is the end of third-party interaction with the doctor, that all will get thrown back on the patient to deal with their insurer and with Medicare.
But there's more. If you don't have to deal with Medicare or their price caps, you also don't have to deal with HIPAA or with PPACA, with CPT codes or ICD-9 or ICD-10, or having to do e-prescribing of having to buy an EHR, unless you want to, unless those things actually show themselves to make your job easier while being efficient and affordable, like anything else you might buy, and not like something the government tells you you have to buy.
In some ways, it doesn't have to be so awful. CMS will hate that. They live for the power to control prices and to make medical practice bend to their will. To save Part B after shoving out a 30% cut, the only thing they will have is to lift the ban on balance billing. That is the only thing that will keep Part B alive in a large reduction scenario. Otherwise it is dead, and they know it.
Just imagine the outrage of the American public then. I am sure they can.