Instability in Medicare physician payment has taken its toll on family physicians, who often are the only doctors available to Americans living in urban and rural underserved areas. Some have stopped accepting Medicare patients, others have sold their practices and become employed physicians for hospital systems, and still others have closed their practices altogether.
A September 2010 survey of family physicians who have an ownership stake in their medical practices found that nearly 13 percent of family physicians say they would consider office closure if the payment they receive for caring for Medicare and TriCare patients is cut by 25 percent Jan. 1.
Here is a sample of what they had to say, in their own words.
“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, if it does, 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.”
“The residency I work for will be under funded and will be in danger of closing.”
“I would stop [providing] care but I am the only physician in the area.”
“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 no where 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 can not 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 21 percent 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 by 21 percent 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 quit office practice of medicine September 3, 2010, to take a government contractor job at a military installation in direct response to Congress' handling of the SGR fix.”
“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 persons I live in 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!”
“If Medicare makes a cut so do all my payer sources, as my contracts with them are as a percentage of Medicare. I don't think I operate on a 20 percent profit. A 20 percent cut may close my doors and force me out of private practice and into an employment situation.”
“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 that come into urgent care who don't already have primary care physicians can't find doctors to take care of them, and 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!!!!!!!!!!!!!!!”
“Most of my friends do not take Medicare. I accept it only because I feel it's ‘the right thing to do.’ I take a significant cut in my ability to provide for myself and my family because I take Medicare, Medicaid, etc. I currently have no retirement money set aside and no college money saved for my 12 year old.”
“Most recent residency graduates are opting to be employed in urgent care centers because they are not willing to pay the price of hospital work or be on call. This is an alarming trend that will undermine the foundation of continuity of care upon which the practice of family medicine stands. I personally don't want to be taken care of in an urgent care/hospitalist disjointed and haphazard fashion when I am sick and have a complex medical history. The combination of four issues needs to be addressed: 1) the cost of running a traditional practice has far outreached reimbursement; 2) society is pushing toward an urgent care ‘give me a quick fix’ mentality — and they don't realize what they lose in doing so; 3) either residency programs are lacking in the ability to instill the proper incentives or desire in the residents, or the wrong people are being accepted into medical school and 4) Medicare and other government-financed health care reimbursements must be consistent and reliable. I don't see how any of our ‘best and brightest’ would be willing to make the sacrifices that we make by going to medical school in the future, considering the uncertainties of reimbursement and constantly rising costs of practicing medicine.”
“My partner and I did not pay ourselves last month due to the delay in Medicare payments
Note: I sold my practice to the local hospital primarily because of reimbursement issues. These Medicare reimbursement problems will only exacerbate problems for private practice. If Congress is really pro-business they need to think about the implications of these cuts.”
“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. Even without the cut, taking care of seniors is considered a money-loser by many primary care providers. 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 21 percent-plus 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.”
“The pay cut (first) became effective May 31, 2010. CMS then instructed their contractors to hold all Medicare payments. This meant we did not receive Medicare payments, and payments from the secondary insurance carriers were held as well. The direct results were a substantial cash shortfall for the months of June and July, and I was not able to meet operating expenses. As a direct result of that shortfall I had to defer principal payments on my SBA loan for two months and take a further reduction in my compensation. Every expense associated with operating a medical practice has increased, and the compensation offered by the government (CMS) and private insurance is essentially frozen. My ability to generate the income necessary to meet the expense of a solo practice is not predicated on fair and just compensation for services provided. It is rather predicated on how much I can continue to cut operating expenses (already trimmed to the maximum) and, more likely how many patients I can squeeze into the day. This occurs at the personal expense of having to delay my arrival home to my family, work evenings and weekends to manage the paperwork associated with caring for patients, and in between find time to manage the business of the practice. I recently referred a patient to a colleague out of state. In an effort to facilitate transition of her medical care out of state, I located a family physician in her new state, faxed relevant clinical information to him, and spoke with him on the phone (all for no compensation ….) We had the chance to speak briefly about family medicine. He echoed my sentiments about life in family medicine (and the business of medicine in general) stating ‘this was not what he thought he was signing up for’."
“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 can not go on.”
“We are now closed to new Medicare patients since July 1 when the last Congressional showdown failed to produce a timely solution to Medicare payments to physicians. We can not 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.”
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