MDNews - Mid Hudson

+++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++ BUSINESS OF MEDICINE The Face of FINANCIAL CRISIS +++ +++ Physicians' M PHYSICIANS, HEALTH CARE PROFESSIONALS AND POLITICIANS ARE ALL ACCUSTOMED TO READING HEADLINES ABOUT THE "DOC FIX" DEBATE AND THE POTENTIAL FOR DISASTROUS EFFECTS ON INDIVIDUAL PRACTICES. HOWEVER, A NEW TOPIC OF COVERAGE IS EMERGING, ONE THAT REVEALS THE BREAKDOWN NOT ONLY IN MEDICARE REIMBURSEMENT, BUT ALSO IN THE FINANCIAL STABILITY OF A SURPRISING NUMBER OF PHYSICIANS. ATTHEW MINTZ, M.D., associ- ate professor of medicine and health sciences at The George Washington Universit y School of Medicine, began his career as a primary care physician — despite warnings from colleagues of disappoint- ing pay — without aspirations of a lavish lifestyle. Dr. Mintz simply wanted to live in the suburbs and save money for his children's college education. Unfortunately, the cost of a modest lifestyle in the Washington, D.C., met- ropolitan area amounts to approximately $250,000 a year — roughly $70,000 more than the average primary care physician's salary. The defi cit grows even greater for those in academia. The Mintz family solution included both spouses working and Dr. Mintz transitioning to a retainer practice. His story is hardly atypical. The wealthy physician typecast is giving way under internal and external pres- sures, including medical school debt, decreasing insurance reimbursements, malpractice insurance payments and rising overhead costs. "There still exists some expectation that if you sacrificed four years in medical school and three to seven years of postgraduate training, you will eventually make a six-fi gure salary and 14 | Mid Hudson MD NEWS ■ MDNEWS.COM live a comfortable life," says Dr. Mintz. "That just simply isn't a given anymore." A Juggling Act In addition to personal fi nancial risks, physician practices across the medical community are experiencing potentially fatal fi nancial challenges. Medicare and private insurance reimbursement levels have steadily decreased as the annual "doc fi x" reimbursement cut has grown to 27.4% and overhead expenses — from employee benefi ts to medicinal costs — have escalated. Primary care physicians are con- fronted by a shortage of go-to procedures to garner reimbursements while some specialties, such as medical oncology, are wrestling with shifts in reimburse- ment rates for drugs that only motivate manufacturers to increase price tags. Those external demands are coupled with mounting debts and the lack of business acumen many physicians carry at the beginning of their careers. According to U.S. News and World Report, the average medical school student has $141,132 in loans upon graduation. "The only way physicians can make up the difference is volume — seeing more patients or doing more procedures," says Dr. Mintz. "Many physicians are fi nding themselves at the breaking point." Hope in Reform From a policy perspective, Joanne Kenen, Deputy Health Care Editor for POLITICO Pro, who has been cover- ing health policy inside the Beltway since the mid 1990s, sees the annual uncertainty over possible Medicare pay cuts as a significant challenge to practicing medicine. However, despite the annual indeci- sion, Kenen notes that, realistically, Congress will never fail to stop the impending "doc fix." The attention to the issue is an indication that national medical organizations are following through on their commit- ment to pressure legislators on issues such as Medicare reimbursement and health care reform. There may even be progress in syncing the two issues as a way to address physicians' financial challenges. "Some lawmakers understand that these two issues are related — that to get away from the [sustainable growth rate] system, they have to come up with a new way of paying doctors," says Kenen. "That new system may dovetail with the 'value-not-volume' push of the health law." ■

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