What Family Physicians Say

Americans are facing threats to their access to medical care. Their family physicians are struggling to remain open after years of instability in Medicare. These physician practices depend on decisions that will be made by Congress in upcoming months.

Whether a family physician can remain in practice depends to a large extent on Congress. Unless Congress acts to halt a mandated 29.5 percent Medicare payment cut before Jan. 1, 2012, more than one in 10 family physician practices could be driven out of business. Unless Congress and the President approve recommendations by the Joint Select Committee on Budget Reduction an automatic, across-the-board cut of 2 percent will be applied to Medicare provider payment.

We asked family physicians about the impact of drastic Medicare pay cuts. Here is what family physicians say….in their own words.

“In Massachusetts our Medicare reimbursement rates are already being subsidized by the commercial insurance rates, but the commercial rates are regularly dropping due to our Commonwealth's health care changes.

“If we are reduced by 30% more I will be unable to afford to provide care to Medicare beneficiaries. Period. There will be no other option.

“It is a clear abrogation of the government's promise to provide medical care to seniors. Moreover, I feel this puts a burdensome and unique tax on me who, as a family physician, finds myself already at the bottom of the reimbursement scale of physicians. Already it is nearly impossible to attract others to primary care. This would put the coffin nail in the hopes to increase primary care physician ranks.

“The solution is not to reduce the unit costs of care, but to put deterrents on the increasing demands of all beneficiaries for the latest and most expensive technologies, and to reduce the malpractice threat on us.

“Someone in decision-making roles has to understand the impossible pressures already on us in the current environment. Putting across-the-board decreases in reimbursement will simply shut off seniors’ access to care.

“I believe we can work together to reduce expenditures, but only when ALL who demand services have the same incentives to utilize resources at an appropriate level. I have already had to stop taking NEW Medicare patients due to the low levels of reimbursement. Please, do not cut the jugular with the foolish 30% reductions being discussed.”

Gregory A. Bazylewicz, MD
Manchester, MA

“I opted out of Medicare 2.5 years ago. Every time I see a Medicare patient in my office (with whom I have a private contract outside the Medicare system), who pays me cash out-of-pocket, I wish that I could at least go back to a "non-participating" agreement, because I know that seniors on a fixed income have budget troubles of their own. But I cannot enter into a business arrangement that puts one-third of my income at risk. I’ve been in practice 11 years, and for the first five was losing money to the insurance system. Now that I have a cash-based practice, I can make ends meet, and pay my staff, my rent, my malpractice, and even myself. So many of my colleagues cannot.

“A 30% cut from Medicare would ensure that I did not go back to a participating or even non-participating status. And I am sure that it would be the final nail in the business coffin for many of my family practice colleagues.

“I would be happy to discuss this with anyone who would listen. I've given up reaching out to the legislature, as I have been met with form letters if I get any response at all.

“We need more than just an SGR fix. We need real and true health care reform. Where doctors are paid fairly and patients can afford coverage.

“If the Medicare system were improved, payments were fair, and coverage remained thorough, and we gave all Americans the option to "buy in" to the Medicare system, it would create a robust insurance plan with plenty of cash flow and a balance of healthy young members to the older or disabled members. It would be, theoretically, free from the profit-driven goals that the current insurance based system thrives upon. And we would be a huge step closer to true "health care for all".

“In the meantime, I will continue at my cash practice 3 days a week, and the free community based clinic for the uninsured 2 days a week.”

Elizabeth Crowley, MD
Cape May Courthouse, NJ

“It's simple. A 30% cut in Medicare payments will mean I will have to close my solo rural practice. It would be the final blow as my overhead continues to increase while my reimbursements, at best, stay flat. This would also give my commercial payers a reason to decrease their payments as they tie their own payments to physicians as a percentage of the Medicare rate. This should be a huge concern to the general public as I am sure it will only add to the erosion of primary care which has proven over and over again as a cost saver to our health care system. In the long run, I would expect to see health care costs increase if payments to physicians decrease as more patients will have to seek care in the ER which may be the only place for them to go.”

Mike Gorman, MD
Logandale, NV

“A 30% cut in Medicare physician payments will severely cripple primary health care in Georgia. We already have a situation in the state where there has been no increase in Medicaid payments in 11 years, while expenses continue to go up and up. There are family physicians in the rural areas of the state who have to work two or three jobs to continue to survive because they lose money each time they see a Medicaid or Medicare patient, which the majority of their patients are.

“A 30% pay cut will drive some of these small business men and women out of business as they will no longer be able to cover overhead expenses. Is this what we really want? Decrease the access to health care in the most needy areas of our nation that need it the most? In the end these patients will seek care later in a disease course, and from providers that will end up costing everyone more (the ER). Not a good way to save money.”

Leonard D. Reeves MD FAAFP
Rome, GA

Other Comments from Family Physicians
  • “Already closed one satellite office, Currently I'm in the red simply trying to stay afloat. Just liquidated my entire retirement IRA to pay office expenses/ accountant and do not see any possible way to remain in business even with the current rates. Office expenses, health and malpractice insurance have sharply increased and benefits decreased. I was able to stay solvent 10 years ago but am currently trying to give away the practice and move out” of the state.
  • “I would not be able to afford to continue practicing. Although I find it hard to believe that the cut will take place, I would probably have to leave private practice and work for the hospital. The cut would essentially eliminate my income completely if I kept the same staffing and medical supply expenses.”
  • “I may have to close my office and seek a salaried job leaving 3000 patients to find some other outlet.”
  • “My practice will fail financially.”
  • “A Medicare decrease will greatly limit access by beneficiaries to medical care. The flawed formula must be fixed. Failure to do so will limit access by those who actually vote. The disruption will result in bitterness on the part of our seniors toward our lawmakers. Failure on the part of Congress to act is tantamount to political suicide.”
  • “Any further decreases in Medicare payments will seriously impede my clinic's ability to provide care for our Medicare patients. We do not have the resources to absorb any further cuts in Medicare payments. We are one of only a few clinics in our area that are taking new Medicare patients and access has been a big issue for the seniors in our community.
    Any Medicare cuts in my practice could spell the end of my private medical practice. I am in a rural area where there is a predominance of senior citizens and nowhere else to go.
    As a family doctor, most of us have long term relationships with our Medicare patients. It would be very difficult to sever ties with these people and we would probably take the financial hit ourselves. I suspect getting specialist care will be very difficult.”
  • “How can I face my neighbors or patients I have taken care of for 40 years, if I turn them away because their (Medicare) insurance is no good? I would quit practicing in my office if I had to do that, and volunteer in some clinic.”
  • “Many patients cannot find a primary care provider because of the shortage of primary care providers. Many of the primary care providers are also talking about dropping Medicare if the cut goes through. Many older providers also will simply retire if this happens.”
  • “I finished residency in 2007 and have just opened a new solo practice. In theory, this should allow me to offer medical care to my patients in the way I deem in their best interest without the bureaucracy of others dictating how I practice. Now, with hundreds of thousands of dollars to pay off in medical school loans and the threat of looming Medicare cuts … I may not see my dream realized; I don't know if I'll be able to keep my doors open. I just wonder if my student loans will be cut as well.”
  • “I have been in practice for 12 years. My practice was a private practice, but had to allow a hospital to take us over or close our doors due to lower reimbursement. Prior to the takeover, there were many months when the physicians were not paid so the mortgage, utilities, and staff could be paid. The proposed Medicare cuts will result in commercial insurance plans following suit. In light of the fact that I am still paying on medical school student loans, the proposed Medicare cuts only add insult to injury for me.”
  • “Have decided to close my family practice office. In fact, out of 14 primary care physicians in (town), six have made the same decision to move on since April 2010.”
  • “I totally believe that cutting Medicare payments will add more to an already strained system. Indeed there is already a shortage of primary care physicians, and it will get worse to find one after Medicare cuts.”
  • “I will continue to accept Medicare patients because I practice in a rural community and these patients have to be cared for. This will still impact patients, I believe, because other physicians in my situation will likely be less satisfied with their jobs, medical students will likely be less interested in going into primary care, and we'll be worse off in terms of workforce shortage. There is absolutely no way that patients or physicians will be better off after a Medicare cut.”
  • “I will take care of the people in the community with as best I can, no matter what.”
  • “I work in a rural setting. Patients need the care. As a physician I need to take care of the patients. With the reimbursements decreasing, I will need to close the office and move on to join another clinic. It is becoming more and more difficult to stay solo, to take care of the business aspect of the patient's care. The bottom line is that the patients will suffer and the consequences will be more costly for the government down the road. We have to put on 'the thinking cap of prevention' as we provide care for the patients. Cutting back the fees by Medicare for the family physician will be more costly later. It does not take a genius to see this!”
  • “It is already difficult for Medicare patients to find a primary care physician. With the proposed Medicare fee cuts, this will become even more difficult. It would trouble me deeply to stop providing care for Medicare patients, especially those who I have attended to for more than 30 years. However, if Medicare reduces its already inadequate rates, I may have no choice but to do so. My Medicare patient visits can be VERY time consuming and I already feel that I am providing subsidized care for these patient visits. To further reduce Medicare rates would feel like ‘an insult added to injury’ situation!!”
  • “It is becoming very difficult to meet the bottom line and to keep my current staff which has been working at maximum capacity for some time now. I will not be able to keep a private office going if income is not increased. If rates are decreased we are done as a private entity.
  • “Medicare cuts might result in the closure of our clinic as the hospital cannot have us stop accepting Medicare as a hospital department. We are starting to lose money as it is.”
  • “Most Medicare patients who come into urgent care don't already have primary care physicians, can't find doctors to take care of them. If they don't like the doctor they have, they have a terrible time finding a new one. Some specialists are no longer taking Medicare patients. It is a sad and soon-to-be desperate situation, and patients are putting off getting their health care until they are so sick, it is almost too late. Medicare (the government) can't expect physicians to keep working harder and harder for less money. Medicare patients tend to be complicated and deserve our very best. Unfortunately I believe they are getting the short stick as physicians become weary of trying to fulfill their Hippocratic Oath (which I believe most want to do) and not getting reimbursed. I do not believe that most physicians go into medicine for the money, however, we give up a lot of our personal lives for our patients, and we should at least be able to be adequately reimbursed. All I can say is that Medicare patients better stick with a doctor, as there are going to be fewer and fewer primary care physicians to take care of them. I had to quit a regular practice and go to an urgent care situation because of burnout. I couldn't see anymore patients in a day then I was seeing, and I was losing money. That just shouldn't be!!!!!!!!!!!!!!!”
  • “Senior citizens very often are politically conservative. They vote for candidates whom they feel are more fiscally responsible. They don't understand these candidates who are willing to cut services to save money are also willing to cut THEIR (senior) services like Medicare also. My group is the only family practice group in town that is taking new Medicare patients and that is BEFORE the Medicare cut. Taking care of the elderly is essentially a philanthropic undertaking. At the end of the day, I can tell my family: ‘Well, I make two-thirds of what many of my family practice contemporaries make but at least I can sleep nights knowing that I am helping those who really need it instead of seeing 35 coughs and colds per day’.”
  • “Simply put, the time and effort to take care of a Medicare patient is great, and any reduction in payment is enough reason to stop seeing them. There is a lot of work that is done away from the face-to-face visit with every single Medicare patient. This requires more than one staff person and will no longer be cost effective. I am very proud to keep my patients out of the hospital, saving the government thousands and thousands of dollars, and they just can't seem to understand or appreciate this most important fact in the economics of Medicare. We love our senior citizens and love our work, but politicians just can't seem to understand all the resources spent around these people. We family medicine doctors are at the bottom of all specialties and the forerunners with the victory banner in saving money for Medicare and now they want to kill the golden goose.”
  • “The Medicare cut would most likely put us and other small practices out of business and force us to eventually close our doors to our patients, because, soon after the Medicare cut comes, all commercial insurance will follow suit as their fee schedule is based on Medicare's. And forget about getting care if you have TRICARE. Which, as a veteran myself, is an outrage.”
  • “This would be a death sentence for primary care; many would retire or change specialties (since pharmacist, nurse anesthesia would make more money). Also, this would encourage most if not all medical students not to choose primary care.”
  • “To my knowledge, the only practice accepting new Medicare patients in (town) is the large clinic owned by the same corporation … that operates the only hospital in town. If that corporation changes its policy, there will be no access at all for new Medicare patients in (town). Many solo practitioners locally have opted out of Medicare, or discharged their patients when they reach Medicare eligibility age. I am on the verge of opting out too. I currently carry a six-figure negative net worth at 56 years old, almost entirely because I have continued to take care of Medicare patients when others would not. At some point my family has to come before my patients. I have spent today about 2-3 hours of non-reimbursable time providing necessary work on behalf of my Medicare patients. This cannot go on.”
  • “We are now closed to new Medicare patients since the last Congressional showdown failed to produce a timely solution to Medicare payments to physicians. We can no longer rely on a payment partner that can not reliably hold up their end of the deal. No business can survive with unreliable partners. I have no idea where new Medicare patients will go.”
  • “We don't turn patients away, regardless of their insurance (or lack thereof), and don't intend to start now. My job is to do the best I can for my patients and be their advocate.”