Obamacare shutters D.C. family practice
A Washington physician, whose father founded his practice in the late 1960s, is shuttering operations because of the burdens created by federal health care reform, in addition to Medicare and insurance company hassles.
Health care regulations and laws created by President Barack Obama’s 2010 Patient Protection and Affordable Care Act are the biggest problem, said Dr. Andrew Lee, a general practitioner who has treated more than 10,000 patients since he opened his business.
“I think all citizens in America should be provided with some access to health care,” he said. “But, I am not sure this is the right way to shovel a massive law through,” he said. “My anticipation is that it will be modified, some.”
Lee said he and his wife, who is also a doctor, took over his father’s practice in 1999 at the same address in the capital’s Chinatown, where his father started it. “He actually grew up in the house next door.”
The doctor was born in D.C., at the former Columbia Hospital for Women, now a condominium complex called The Columbian. “When I walk by with my kids I tell them: ‘You know, I was born there, I could retire there,’” he said.
“My wife and I would have this discussion for years, but it was not until three years ago, did I realize we are really fighting a losing battle,” he said.
“I am not sure if it is 100 percent related to government, as much as it is also the health insurance companies,” he said. “They tend to have a lot of factors in there that make you do things like pre-authorizations, which increase your administrative time.”
Joining Johns Hopkins
Regardless of who controls the White House and Congress, Lee said the business will close some time next year. “We are going to close our practice and join Johns Hopkins University,” he said.
Johns Hopkins is a Baltimore-based institution that is expanding its operations into Washington, he said. The school does not buy practices or have private practices inside its own business, so the couple will actually close the business and become salaried employees of Johns Hopkins, although they will take their patient records with them with the intention of treating them at their new home.
“I’ve told our patients we will be just seven blocks away and that Hopkins is committed to practicing very good medicine,” he said.
One of the considerations he and his wife dealt with was the transition from running their own business and being their own boss, he said. Initially, giving up the “ownership” of one’s job was difficult, the doctor said. But, in another way, Lee and his wife are glad to be freed from the hassles from the government and insurance companies, he said.
“My wife and I look forward to it because we can just focus on being a good physician, not worrying about the administrative headaches,” he said. “We really looked at the benefits versus the risk and we were really unsure about what is going to happen with the Affordable Care Act,” he said.
“In my view, the two winners for the Affordable Care Act are the insurance companies, because more people will have to purchase insurance, as well as the pharmaceutical companies because many more people will be buying medications—they are the two lobby groups that have fared pretty well from this.”
For Lee’s Medicare patients, the problem is not the reimbursement rates, which in some cases is more generous that what private insurance companies pay, he said. “What really hurts us—with Congress unable to come to a budget, and the fiscal crisis in January—they have always talked about cutting 27 percent if this thing goes through,” he said.
“They usually come up with a stopgap for another six months, but we are always under this threat,” he said. “The last one that happened last year, and the year before, our Medicare clearing house tells us: ‘Just don’t submit anything for one month—and then after the stopgap comes through, then send the billing in again.’”
The result is that the practice loses its Medicare revenue for that month, he said.
No tort reform
“Another problem is that there is no tort reform on the table,” he said. “That is a big problem here in D.C.—there is no cap on the personal injury portion of malpractice—all these things add cost, and our costs are going to run us out of our practice.”
Without tort reform, malpractice insurance keeps going up, he said. Lee pays $25,000 per year, and his wife roughly half that, for $1.5 million per occurrence, with a total coverage of $3 million, he said. “There is no deductible, and the premium is non-tax deductible.”
The doctor said the tort situation makes it very difficult for doctors to find an insurance company and that in turn makes it an unwelcome environment for doctors to practice in the city limits.
In the end, the neighborhood doctors like him are going away, said the graduate of the New York College of Osteopathic Medicine, Old Westbury, N.Y.
“What people really like is the access to their doctor,” he said.
“We deliberately run this as a very small practice. There are no nurse practitioners, no physician’s assistants, we just have the two staff people up front and me and my wife,” Lee said. The practice does not accept new patients, unless they are friends or related to existing patients.
“We have used electronic record keeping since 2006,” he said. The government is forcing doctors to use computers to cut down cost and electronic records to cut down on paperwork, he said. “What that does is put the onus of the cost on the individual physicians.”
Under the federal government’s “Meaningful Use” programs, if computer equipment was purchased in 2011, the practice could put in for reimbursement, he said.
The problem is that Lee and his wife bought their system in 2006, he said. New regulations require completely new computer systems in 2013, which for the Lees would cost $15,000 to $20,000.
Because they are shutting down their operations in 2013, they are ignoring the law for now, he said.