I am an addiction medicine specialist in rural Washington. Despite serious access issues to my specialized services and the morbidity and mortality involved, I have decided to opt out of Medicare because of the administrative liabilities. Furthermore, I find it unacceptable that patient confidentiality is so wantonly disregarded for unwarranted audits. 

Numbers of your constituents will suffer and die as a result of current Medicare policies that impact small rural practices. Current estimates of costs saved for addressing substance-use disorders is arguably as dramatic as for almost any other common disease. I cannot afford the administrative liabilities, let alone financial disincentives. 

Furthermore, patient confidentiality is highly compromised by audits. Particularly upsetting when indicators for same are highly problematic. I am urging U.S. Sens. Maria Cantwell and Patty Murray, and U.S. Rep. Derek Kilmer to do what they can to assure highly cost-effective care for your constituents. 

Please be concerned about the unintended consequences of zealous regulatory efforts that make providing the care unaffordable for smaller rural practices.