A doctor representing the American Association of Orthopaedic Surgeons told The Daily Caller on Thursday that “physicians have reached a tipping point” under current health care laws, as they cannot both care for their patients and comply with mandated regulations.
Dr. Louis McIntyre, from Westchester County, New York, testified with three other health care experts before part of the House Small Business Committee on Thursday to explain the increasing challenges Congress and insurance companies have put on doctors who work for small or solo practices.
Rising costs of malpractice insurance and regulatory paperwork, along with shrinking reimbursements paid to doctors on behalf of Medicare patients, have all but forced doctors to become hospital employees, McIntyre said. He believes patients will see the quality and accessibility of healthcare deteriorate as more and more doctors, struggling to eke out a profit, leave their private practices for hospitals.
“Doctors know that they cannot meet all the demands placed upon them in an environment of shrinking revenues and increasing costs, and take care of patients at the same time,” McIntyre said.
The malpractice insurance at McIntyre’s Westchester Orthopedic Associates increased from $40,000 to $110,000 per year per doctor between 1994 and 2010.
Now, McIntyre and his colleagues work for White Plains Hospital, which pays their insurance premiums. In turn, they must comply with hospital policies over their own — or their patients’ — preferences, but hospitals give doctors more financial security and free them from having to deal with troublesome regulations imposed by insurance companies and Congress.
In 1995, Westchester Orthopedic employed one person to perform administrative tasks. By the late ’90s, they employed one per doctor.
Mark Smith, president of physician recruiter Merritt Hawkins in Irving, Texas, said there are more regulations today than ever before. Doctors in his association report spending 60 percent of their time on completing regulatory paperwork.
“There have even been reports of small practices going out of business,” Smith said. “This has been unheard of in my 24 years in this organization.”
In 2009, the American Recovery and Reinvestment Act mandated specific data collection that increased costs on doctor’s private practices without increasing reimbursements. The next year, the Obamacare decreased reimbursement and specified more reporting requirements — again increasing costs.
McIntyre and his colleagues formed a network of orthopedic surgeons to increase their market share and negotiate with insurance companies for more reimbursement, but their negotiations failed.
Democratic Rep. Janice Hahn asked the doctors if medical school prepares students for business, to which they agreed it does not. McIntyre believes doctors shouldn’t need an MBA to run their practices successfully, but probably need one today to comply with regulations.
“I really don’t think it’s that much rocket science that you need an MBA,” he told TheDC. “The time it takes to get an MBA after the time it took to become a doctor — it took me 13 years of training to become an orthopedic surgeon specialist. Another three years at an MBA is a daunting prospect, to tell the truth.”
The American Academy of Orthopaedic Surgeons estimates that orthopedic surgeons’ revenue from Medicare reimbursements has decreased 28 percent in the past decade, and hospital employment of the surgeons has increased 300 percent in the past five years.
McIntyre believes this migration will encourage process-driven care over outcome and goal-driven care because hospital administrators may not appreciate patient care issues like the physician treating them would. He also said hospitals are less willing to try new methods.
He fears medicine will morph from a profession advocating for patients into a trade association advocating for physicians, and he proposes market-based solutions.
“I think if patients have some significant gain they are more likely to seek health care that is of quality to them,” McIntyre told members of Congress. “If somebody else is paying for their health care, especially if it’s first dollar coverage, they are less likely to become shoppers, they are less likely to search for quality. They are much more likely to search for volume.”
Drs. Joseph M. Yasso and Jerry D. Kennett also testified, representing the American Osteopathic Association and the American College of Cardiology respectively. Republican Rep. Mike Coffman chaired the subcommittee.
McIntyre said that he hopes the subcommittee will, from now on, consider what their actions require of doctors.
“Maybe we should have started with you at the very beginning, talked to the physicians before they started writing a 2,000-plus-page bill that many of them [politicans] didn’t read, yet passed,” Republican Rep. Scott Tipton said. “[Then-Majority Leader Pelosi] said we”ll find out what’s in it once it’s passed and, unfortunately, that discovery is still continuing.”
Videography by Sally Nelson