NOTES FROM THE ER

Endless bureaucracy is forcing many doctors to leave practices

Any doctor treating Medicare patients is responsible for following more than 110,000 pages of policies, rules and regulations.

JOE PELLICER, TOM BURKE

Originally published May 21, 2001

Readers: A friend of ours, Dr. Carl Ott, writes today's column. It concerns a different kind of emergency that confronts our profession and our society.

It's getting a little lonely being an internist in Olympia. There were 13 of us at Memorial Clinic a year ago; at the end of May, only five will still be practicing in Olympia. It's like a sad game of musical chairs -- no one knows how many will still be standing in another year.

The job itself is great; the time spent with patients is still satisfying and rewarding. Hopefully, this is equally true for my patients. One hundred years ago, a physician gave a simple definition to the essence of medicine: "Every time a doctor sees a patient, the patient should feel better as a result." That remains the goal.

A major challenge to that goal is dealing with an increasingly Byzantine system of reimbursement. Recent surveys have shown the average physician devotes 40 percent of his or her time to paper instead of people.

Regulatory nightmares

Here are a few examples: Any doctor treating Medicare patients is responsible for following more than 110,000 pages of policies, rules and regulations.

That's three times longer than the U.S. tax code. If doctors decide to ignore the 35 pounds of regulations and updates they receive in an average year and just practice medicine, Medicare has two words for them: "fraud and abuse." Large fines, even prison terms, threaten physicians caught making paperwork errors.

Medicaid, the government's health program for the poor and disabled, recently introduced its own version of fraud and abuse monitoring, called the payment integrity program.

Nobody expected a thank-you note from Medicaid for treating patients at rates well below cost; it was done as a service to the community. Instead of putting funding toward Medicaid's absurdly low reimbursements, the program requires extra audits.

Since this program was announced, most local physicians have stopped accepting new Medicaid patients. No one cited the low reimbursements, but everyone objected to one more government agency increasing the "harassment" factor, and the assignment of criminal intent to billing errors.

Private insurance companies have developed their own game. It's called: How little can we pay the doctor? Increasingly, insurance reimbursements to primary-care physicians have reached levels that are below the cost of doing business. We are in the unusual position of having to turn away customers to provide service to existing ones, yet still not collecting enough to be certain our doors will be open next year.

Our patients have been great through the turmoil. Many have asked what they can do; some have even volunteered to put in time at the office, helping with paperwork.

What to do?

There is one important thing everyone can do if you want your own physician in practice next year: Contact your legislators.

Tell your national representatives to help pass the MEFRA act, a bipartisan bill that would provide simplified regulations and end criminal sanctions for honest mistakes.

Tell your state legislators to abolish the Payment Integrity Program. Unless the intent was to create a separate health-care system for Medicaid patients, it needs to be ended.

Tell both to adequately fund Medicare and Medicaid reimbursements. Together, they provide 30 percent of health-care funding in Washington. This truly is a crisis. Clinics are closing, other providers and hospitals are on the verge, and some will close in the next year. Action is needed now.

Joe Pellicer and Tom Burke are physicians at Providence St. Peter Emergency Department. Send your medical questions, comments or stories to Notes from the ER, Olympia Emergency Services, Providence St. Peter Hospital, 413 Lilly Road, Olympia, WA 98506.

The Olympian Copyright 2001

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