Like every other family physician with Medicare patients, I was horrified when Congress failed to stop the 21.3 percent Medicare payment cut that took effect June 1. A few weeks later, I sighed with relief when Congress finally rescinded the cut and passed a 2.2 percent payment increase. But that modest increase is only until Nov. 30. After that, who knows what will happen?
Linda Stewart, M.D.
Furthermore, who knows when Congress will finally fix the sustainable growth rate, or SGR, formula for Medicare pay? I certainly don't.
In spite of the uncertainty and the inadequate pay, I have decided to continue accepting Medicare patients in my solo practice. Why? It's more a matter of philosophy than of economics. It's about my purpose and my aim in being in family medicine and this practice.
For me, being in practice is about much more than just earning a living. I went into family medicine to be of service to others. After residency, I opened my practice to serve the people in this community. I've practiced in the same location for nearly 35 years, and my practice has grown up and grown older with me.
I'm also aware that my medical education wasn't paid for just by me. I covered my own tuition, thanks to student loans, but taxpayers put a lot of dollars into my education, too. I have my career thanks, in part, to the American public, and I owe them for it.
In addition, Medicare is a positive thing for my older patients, including Part D, which is so helpful regarding their medications. Before Medicare, people who didn't have cash or insurance were often too embarrassed to ask for care. Or they got the care and paid what they could, if anything. Doctors weren't going to turn away families they'd seen for 20 years, so they wrote off an astronomical amount of bad debt.
Sometimes the only reward the doctor received was the patient's goodwill -- the fellowship and handshakes at church. Those doctors gave their service and hoped for some payment to keep going. Now, with Medicare, we may be underpaid compared to what our expenses are, but at least we are guaranteed that we're going to get something. It's much better than it was 50 years ago.
Although I'll continue to accept Medicare patients, I don't take Medicaid, and I'm not in the Women, Infants and Children Program. Both are simply not cost-effective, and the billing is extremely complicated. But other physicians in my community do participate in those programs, so people have access without my participation.
That's not necessarily the case with Medicare. If I were to stop accepting Medicare patients, some of the people I would turn away might not be able to access care somewhere else. How could I deny those people the care they need?
So I'll continue to look for ways to shave expenses and keep my practice afloat. In the past, I've reduced staff from five people to three, and I've discontinued procedures that weren't cost-effective, although I felt personally fulfilled doing them. I'm fortunate to own my own building, so I don't have to worry about the rent. But I have put off purchases, such as an electronic health record system. I just can't justify that expense while reimbursement shrinks faster than dry ice in the desert!
One change I might consider is to stretch out the interval between health maintenance visits for Medicare patients with chronic diseases, such as diabetes, because the cost of each office visit is greater than the payment Medicare provides. I'll do it only if I can find research showing that patients can be kept on track with less frequent visits than my patients get now, but I won't do it if it could cause harm. Of course, any patient who gets sick will be seen as soon as possible.
Will the situation ever get so bad that I change my mind and stop accepting new Medicare patients, or get out of Medicare? I honestly don't know. I hope not.
But when I feel anxious about such questions, my worries quiet as I consider what my true objective in medicine really is. And it's not all about the money.
Linda Stewart, M.D., is a practicing family physician in Baton Rouge, La.