Tuesday, August 20, 2013

Life Imitating A News Article, Imitating Life

While having lunch the other day, I was talking with two physicians, one retired from active practice and the other having practiced for close to 30 years. The conversation turned to physicians today and the financial difficulties they face. Retired Physician was a Cardiologist. With steady decrease to medical reimbursements over the years, Retired Physician made less money each year he practiced, while his skill and expertise increased. Since medicine is paid by a piece meal basis, payment is for each patient served and the only way to make more money is to see more patients, physicians are burning out and going broke.

This isn't a big secret; a recent CNN piece noted that  “[t]his quiet reality, which isspreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

As our conversation continued, Retired Physician lamented that as his practice grew (at one point there were 49 employees), his pay and his partners' pay continued to decline as more money went into payroll, benefits, malpractice and overhead. Even though he had never been sued, his malpractice insurance premiums continued to rise each year. What finally made him retire was when he had to make a decision about which long-term employees to let go (some had been with the practice for 20 years) in order to stay in business, or what benefits to cut in order meet other financial requirements.

Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year.  "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."

What we all agreed on was that with the low reimbursements and growing federal regulations, medicine is not the once-lucrative business that had attracted our best and brightest. Today’s physicians will face a lower standard of living due to higher debt to pay back and lower incomes.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat.  "Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."”

Medicine in America, motivated by success, had become the stalwart in the world. Our physicians, considered to be the leaders in medicine, had breakthroughs that have increased our life spans and our quality of life. Diseases, once life sentences, have been conquered and others have treatments that allow individuals to continue to live productive lives. How have these men and women been rewarded? By facing constant cuts to their very livelihood, they may not be able to continue to practice their chosen profession.

On average, there's a 10% to 15% profit leak in a private practice," he said. Much of that is tied to money owed to the practice by patients or insurers. "This is also why they are seeing a cash crunch." "The economics of providing health care in this country need to change. It's too expensive for doctors," he said. "I love medicine. I will find a way to refinance my debt and not lose my home or my practice."

As we ended our lunch - a retired physician, a still practicing physician and a health care executive - we hoped that the business and profession of medicine would not end, but continue to grow and prosper.

Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary "patch," this dilemma continues to haunt doctors every year.”
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