LAS VEGAS (AP) -- Some Nevada doctors are flat-lining economically over reimbursement plans they say are too low. The dilemma could force many to leave a state that already faces a shortage of doctors, according to the president of the Nevada Association of Family Physicians.
"We're chasing our tails. We're in a losing game," said president Bill Pierce.
Pierce's solo family doctor practice in 2005 brought in a half-million dollars, but he ended up $32,000 in the hole. He took out a $100,000 home-equity loan to cover the difference.
Today's world of health care has forced Pierce to be as much a businessman as a healer and he said he's not alone.
Doctors' biggest challenge these days is not treating ailing patients but navigating a complex maze of reimbursements from 150 insurance companies, he said.
Each insurer reimburses doctors at different amounts based on separately negotiated contracts - and physicians' revenues can drop even as costs increase.
Pierce estimates he needs to generate $272 an hour to cover his costs - from malpractice insurance to rent.
That means seeing dozens of patients every day. He doesn't want to treat them as so many widgets, so he tries to spend a decent amount of time with each. But that just gets him in financial trouble.
His practice has 4,300 patients. A third of them are covered by Anthem Blue Cross and Blue Shield. It used to pay Pierce $66.53 to see a patient for a typical 20-minute visit. It was recently cut to $47.37, some of which may be paid directly by the patient.
By comparison Medicare, the federal government's insurance program for people who are disabled or over age 65, pays $84.51 for the same type of visit, Pierce said, though those rates are also expected to drop.
The reimbursement rules mean that sometimes it pays more for the doctor to inconvenience patients, he said.
For example, when a Blue Cross patient needed a skin lesion removal, a procedure that takes 30 minutes of staff time, Pierce had the option of delaying the procedure to a future visit and receiving about $30 from Blue Cross. Instead, he removed it immediately and was reimbursed 73 cents.
In most industries, business owners can charge more when their costs rise, but that's not the case for doctors.
Dr. Florence Jameson, an obstetrician-gynecologist and president of the Clark County Medical Society, said many doctors are forced to join groups and share administrative costs. The solo practice, she said, may become a relic.
"It is a big deal and it's a sad thing, and it's unfortunate that medicine now is just big business, it's now corporate," Jameson said. "It will never go back to the way it was 20 or 30 years ago. Too many people have found out how lucrative it is to be a middle man in medicine."
Jameson said insurance companies are forcing family doctors to change the way they practice. For example, many doctors are extending the reach of their practices by using more physician assistants or nurse practitioners to treat patients. Fewer patients are treated by doctors.
Pierce said he can't keep up with the insurance companies' changing rules and guidelines.
He just knows one thing: If they cut back on how much they reimburse him to see their customers, he may be forced to stop seeing them. Other doctors have dropped patients for the same reason - inadequate insurance reimbursements.
Pierce said he is forming an additional branch of his practice that will bypass insurance companies.
Patients who join the program - tentatively called Your MD -would eliminate their comprehensive health coverage. Instead, they would carry less-expensive catastrophic coverage and pay Pierce $2,000 a year - about what many people pay for health insurance - for up to 10 visits, annual lab work and a nutritional assessment.
He said he would limit the number of patients in the new program to 600, so they can have his full attention. In return, he'll get paid up front by patients.
And he won't have to deal with their insurance companies.
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Information from: Las Vegas Sun, http://www.lasvegassun.com
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