February 2002 • Volume 8 • Number 2 |
 Baretta Casey, M.D., consults with Medicare patient Mary Jackson, 90, about a foot problem. |
Family physician Baretta Casey, M.D., has a message for the Centers for Medicare and Medicaid Services. It has to do with Medicare reimbursement -- especially the largest-ever conversion factor cut of 5.4 percent that took effect Jan. 1 (see story, page 1). And she sure hopes someone at CMS is listening.
Casey has done what the government wants many physicians to do: set up practice in an underserved area, taking care of many patients on Medicare and Medicaid. She came to medicine later in life than many do, as a wife with two children -- three by the time she graduated. She wanted to become an FP and practice in her Appalachian hometown of Pikeville, Ky.
Her business background stood her in good stead. She bought an office building at an auction, rented out the top floor to offset the cost of her first-floor office, computerized her practice from the start and opened her doors as a solo practitioner eight years ago.
"The first day of practice, I saw 17 patients," Casey recalled. "By the end of the week, I was seeing 30. And it hasn't slowed down one iota."
Thanks to the booming practice and conservative living, Casey paid off $145,000 in student loans her first full year. But that was as good as it got. Ensuing years didn't get better. They got worse.
"I have watched medical expenses continue to grow," Casey said. "As a solo practitioner, I pay for everything. And the increase hasn't been the measly little percentage you hear forecasted by the government. I've tracked it on my computer. It has gone up 10 to 15 percent every year."
Which wouldn't be such a problem if reimbursement rates kept up. But they haven't -- just the opposite. Casey knows: She's been tracking those on her computer, too.
"It took about six years, but at the six-year mark, they literally met in the middle," she said. "The past year, they crossed over. And now, I have to dip into my savings to cover the extra expense. I'm basically subsidizing my own practice."
Other physicians have told her they've borrowed at the bank two or three times already to cover salaries. "That's very scary," she said.
And now, in 2002, the worst blow of all -- the 5.4 percent cut in the Medicare conversion factor, which is tied to the plummeting gross domestic product. "I've had to make some decisions," Casey said. "I won't take any new Medicare patients or take new patients with any insurance company that follows suit and drops payment.
"I currently pay an employee one week of each month's salary just to fill out indigent medication forms, mostly for Medicare patients with no drug coverage. I may be forced to stop this free service to my patients."
And ultimately, she said, "If things don't change, I probably couldn't stay in practice any more than two more years."
Which brings this story to Baretta Casey's message for CMS:
"If our reimbursement rates continue to go down and our expenses continue to go up, you will see an exodus of physicians out of rural areas like Moses out of Egypt. It's not because doctors don't care about their patients. They do, tremendously.
"It's because nobody is going to continue in a field or in a business when they're losing 10 to 15 percent per year. Try to explain to Capitol Hill that the practice of medicine is like other businesses: The only way you can survive is to be able to pay your bills."
Casey is fighting for change, involved in organized medicine, doing what she can. She's vice speaker for the Kentucky AFP and an alternate delegate from Kentucky to the AMA House of Delegates.
Last December, during AAFP's luncheon at the AMA house interim meeting, Casey went to the mike to speak her mind. As she spoke, a ripple of recognition ran through the family physicians in the room. Here was someone telling it like it is -- telling their story with eloquence and passion.
CMS, are you listening?
FP Report is published by the
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Copyright © 2002 by
American Academy of Family Physicians.