May 2002 • Volume 8 • Number 5 |
For a growing number of family physicians, Medicare payment cuts ultimately could break up the "families" dependent on them -- families composed of patients, employees and entire communities.
While some FPs have stopped accepting new Medicare patients, others are putting personal loss on the line to keep their "families" intact.
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| Ronald Johnson, M.D., stands astride the farmland he's mortgaged to save his practice. Inset: Leonard Guthrie, 91, of Pleasant Hill, Ill., who suffers from a heart ailment, visits Johnson for a check-up. | |
One rural doctor in Illinois who borrowed money to meet his payroll is now borrowing against his dream farm to repay those loans and protect his practice from financial failure.
Medicare patients make up one-third of the Pittsfield practice of Ronald Johnson, M.D, and the area's only hospital claims nearly 80 percent of its patients use Medicare. With an average age of 58 in the two counties Johnson serves, "we don't have the choice of not taking Medicare patients. That's our life here," he said in a recent telephone interview. "They are our neighbors; they are our friends. We have to take care of each other."
When he added the losses from Medicare reimbursements and accounts receivables that have doubled in the past six months, Johnson realized he needed to borrow an amount that nearly equaled the value of his farm.
"I got lucky," he said, "because the farm has been taking care of itself financially. Now, it's going to take care of us and our patients."
Johnson is finalizing a loan for two-thirds of his farm's value. It's an amount that realistically, he said, can sustain his practice for another year -- two at the most -- depending on factors including future Medicare reimbursement rates, the local economy and land values.
"I'd never thought I would spend this much of my time being a businessman," he said. "It's such a joy to sit down and see a patient. I thought that was what I was training for."
AAFP Director Arlene Brown, M.D., of Ruidoso, N.M., said she and her staff "saw the writing on the wall" when Medicare physician payments dropped and accounts receivables increased. Something had to happen to keep her "frontier medicine" practice open.
Brown serves 8,000 patients, some of whom must drive 50 miles on a dirt road to reach a paved road -- then must drive another 100 miles to her office. At least 30 percent rely on Medicare, she said, "and we can't stop accepting these patients."
So Brown took a pay cut and turned to her staff for help. The employees -- a close-knit "family" -- didn't want to see anyone lose his or her job, she said. Instead of eliminating a position and/or cutting patient services, all staff members agreed to cut their hours and pay by 15 to 18 percent.
"We must stay open," Brown said. "We know if my patients have to get their primary care 200 miles away from home, they won't go get it. They depend on me, and on us."
How long can her practice hold out for a permanent financial solution? Not long, Brown said. She's hoping efforts to get the federal government to rethink Medicare and correct the physician payment formula will succeed soon.
"If not, we'll be cutting some services we don't have to provide," she said. "The first to go will be flu shots." Next to go will be the free assistance older and low-income patients get when they need help to buy prescription drugs.
"It all makes for bad medicine," Brown said, "but it could help keep our doors open."
If her practice closes, the entire community -- her community -- could collapse, she said. "A majority of Americans eat, live, sleep and die in small communities. If we shut down the very things that help small communities survive, like medicine, then those communities will die."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.