Sunday, July 08, 2012

Affordable But Inconvenient Health Care

Empty Medical Office Building, Florissant, MO (Click to enlarge)
Any takers on this property?

Didn't think so. 

While health care reform has benefitted large health care systems, it continues to decimate small practice physicians.  This portends an ominous outlook for health care in small-town and rural communities. From Medscape Cardiology (registration required):

One third of physicians in small group practices who responded to a recent survey expect their 2012 income to fall below what they earned last year.  Financial pressures could have a devastating effect on physicians in practices of 10 or fewer participants: 26% surveyed said they might have to close their practice within the next 12 months.

"The survey was emailed in April to a random selection of 15,000 of the 200,000 physicians who are registered members of MDLinx, a medical news website, and 673 responded," a spokesman told Medscape Medical News.

A total of 49% of small practice physicians reported cutting staff and services to reduce operating expenses. Despite such measures, 23% said they have used personal savings, and 20% have had to borrow money to cover expenses.

By comparison, only 13% of physicians at larger practices or hospitals expected their income to drop this year.

"This poll is quite startling in the revelations about small practices, the healthcare lifelines to many communities," said Stephen Smith, chief marketing officer for MDLinx. "Physicians have had missiles raining in on their practices at an increasing pace—the economy, regulations, paperwork, insurance, lawsuits, etc."

... "The coming retraction this survey hints at," said Smith, "would mean longer drives to less-personal, higher-cost medical care for millions of Americans."


Andrew_M_Garland said...

Characteristics of regulation.

(1) Regulation is always applied with a broad brush. The regulators cannot conceive of the true complexity of many areas of life. Regulations are infinitely complex because even simple flexibilities in life require many pages of detail to describe and control, and still get it wrong. For example, try to describe how to pick up a coffee cup, or when penalties should be applied for not keeping an appointment. Where the brush is deficient, entire areas disappear from practice or are distorted.

(2) The regulations for any moderately complex system cannot be followed. There are too many rules and too many exceptions. Large institutions have political clout. An eager junior regulator will not make his mark by attacking a large group.

He will audit a small group to bring more compliance into the land. Who will start a small practice when an eager regulator can drop by, require information, and shut the place down, as a warning to all of the other practices.

Dennis said...

I live in a county (Citrus) in Florida that is relatively small in population and there are no high rise buildings and super highways. The big attraction is three rivers that lead to the gulf of Mexico with fishing and nature preserves abounding. We are a major retirement county and there are three hospitals all about twenty miles apart and there are hundred of medical practices surrounding the centers with other facilities popped up like mushrooms throughout the county. Seems like a thriving business... at least for the present and I see no reason to think it very different in the future.

Anonymous said...

The building in your post isn't empty, Metro Imagining is within part of the building - there is space available still.

Anonymous said...

I await your blog on the closing of the last abortion clinic in Mississippi.

Keith said...

It is not so much the regulatory enviorment that is driving physicians out of private practice. It is more the economics of having to compete with large medical consortiums that leverage either their size or reputation to extract increased reimbursement from payers, often with no justification. Add in the non profit status that allows these large institutions to avoid any tax on their profits and you can see why it would be difficult to compete.

In Mass., they have documented the ability of large instituions to leverage their size and even for smaller hospitals that are isolated from regional competiton to extract higher payments. This starves smaller providers who do not have the equivalent resources to comply with the edicts of health care reform.

Blame Obamacare, but this would likely be happening (and has been happening for a long time if you pay attention to the percentage of employed physicians)regardless. Just like the old pharmacies of past times, we might eventually get a Mayo clinic outlet disemminated throughout the country much like Walgreens and CVS stores (wonder if they will sell cigarettes and liquor on site as well!)

Anonymous said...

What Keith said.


Anonymous said...

The looming 'crisis' seems to be ignoring the existing crisis.

As Melissa wrote in a forum at

Called to the ER a few years ago for a patient in cardiogenic shock. He knew he was having a heart attack, knew if he came to the hospital his family would incur a huge hospital bill they could not afford. When he coded about 6 hours into his MI, they called the ambulance. They incurred the ER visit and the ambulance bill.......and a funeral bill. Less Expensive than an overnight stay for a PCI. Yes, I know it was a poor choice, poor judgement, but most of us have not been in the position of losing a home, automobile and ability to buy food. he did not want homelessness or hardship to be his legacy. It was a horrible, sad and preventable tragedy. You can say what you will about how great our free market system is, but this particular scenario would have never happened in England, perhaps.

Anonymous said...

In reference to: Anonymous 10:01's post

This is not irrational thinking on the part of a person who is poor (not by choice).

It's situational thinking and it's completely logical. I'll even call it heroic.

Providers, if you care to pay attention to your patients, your family/friends, your community, you will know that it's becoming the norm not to seek treatment - that is, for those who would feel that they have an obligation to pay for the things they purchase. Choices must be made, and good people are making them - it's where this country is now.


Anonymous said...

Dean Anon 10am:

I had a patient who also presented with an AMI. He was admitted at 3am and went directly to the cath lab where a stent was placed in his LAD. He was out of the hospital severals days later. A month following his MI, he returned to the office with his bill.

He chuckled at my charges. Between an admit, discharge, cath and stent, I received a little over $1000. The patient was a mortician who informed me that he charges three times that for a simple funeral i.e. cremation.

To summarize, a physician is paid less to save a patient's life in the middle of the night than the cost of that same patient's funeral. Physician's are a BARGAIN in this country and every year our fees are discounted by the politicians who just as soon blame us for running up the cost of care (cutting legs off for $60k).

Doctors as scape goats--sounds like a good enough reason to cut more. Bring on the SGR.

Anonymous said...

Besides the fact that the mortician is paying for the building, all the staff involved, paying for the cremation itself, (which would be equivalent to the hospital bill, not MD charges) and the fact that your anecdote reflects more upon the exorbitant cost of mortician services than the cheapness of health have a point.

Anonymous said...

Besides the fact that the physician is paying for the building, all the staff involved (PA, nurses), etc, etc. Take your sarcasm to the back of the line that forms for my exorbitant services...