Embarrassed. Ashamed. Failure.
These words don’t typically describe an accomplished doctor, but Martha Boone doesn’t fit the mold. The Atlanta urologist is an outspoken critic of Obamacare, warning her patients about its disastrous consequences and alerting fellow doctors to the ramifications for her profession.
Lately, however, she’s spent more time worried about the survival of her own practice. With the new health care law about to add more patients to government-run insurance programs, Boone wondered how she would survive with dwindling Medicare reimbursements to cover her older patients.
Because many doctors double as small businessmen, they face the reality of meeting a bottom line in addition to treating patients. Boone figured she had three options: lay off her office manager, drop patients who rely on Medicare or relocate her office.
She didn’t like her options, but didn’t have much of a choice. After months of agonizing over the decision, Boone this month moved her practice to a less expensive office in an older building. It was hardly the ideal outcome, but it allowed her to keep her staff intact and continue treating her Medicare patients.
“I feel a sense of shame; I feel failure because, on some level, I want to provide the very best for my patients and for my employees,” Boone said. “But it’s getting to the point where the bottom line is coming up and we’re just not able to sustain what we’ve done in the past.”
Boone isn’t alone. Doctors across America are facing the same types of tough choices. An American Medical Association survey of more than 1,000 physicians earlier this year found 68 percent would limit the number of Medicare patients they take if the reimbursement problem wasn’t resolved.
The issue took center stage in Washington last week as Congress retroactively canceled a 21.3 percent cut in Medicare reimbursements and replaced it with a 2.2 percent pay increase for doctors. But the temporary fix simply punts the problem to November when lawmakers will again need to act to avoid another cut.
The consequences are startling. At a time when the Obama administration promises more people will have health insurance, there might not be enough doctors to treat them. Boone said physicians in their 50s are retiring early and young people are choosing other professions.
“When I was growing up, we believed that if you really worked hard and got a great education, that you would have a really good life in America, that you would be affluent, that you would be prosperous,” Boone said. “And I think, what I’m experiencing personally is happening all over America.”
Medicare impacts Boone’s urology practice more than others because the bulk of her patients are older and require care for urinary problems that develop later in life. Boone has two employees who spend most of their time fighting with the government over payment problems.
“I absolutely detest that part of my life,” she said in disgust.
She said the situation became so bad with Medicaid, an insurance program for the poor, that she stopped seeing those patients four years ago. When the government paid none of its Medicaid bills for 18 months, Boone simply gave up. She doesn’t want the same to happen with Medicare, given the difficulties patients are already experiencing.
The AMA estimates one in four Medicare patients who are seeking a new primary care physician are experiencing difficulty finding one. That situation has played out repeatedly right in Boone’s office.
“In one day, I had three patients in the office whose primary care cardiologists had stopped taking Medicare and all three of these patients had to go to the emergency room,” Boone said. “This is absolutely a travesty.”
Boone said she’ll continue to make tradeoffs to practice medicine. Five years ago she moved to a less expensive home and two years ago her husband opted for a cheaper car.
But she won’t change the way she practices medicine. While some doctors have moved to a model of seeing up to 60 patients per day, Boone treats no more than 25 per day. “I will not go to a model where I only spend four minutes with a patient.”
Given the challenges, then why do it?
“Every day when I get in my car and go home, I can think of at least five to 10 people that I have really helped,” she said. “So many people don’t get that out of their job.”
Only now, in addition to helping people through medicine, she’s turning to political activism as well. Obamacare has made it necessary.
“I never imagined that I would have to become politically active to take good care of my patients,” Boone said. “That’s added a whole other element to the life of being a doctor.”