Declining Payments And Crippling Malpractice Premiums Are Hitting State Doctors Hard – And Chasing Some Of Them From The Field

By MATTHEW C. KATZ
http://www.courant.com/news/opinion/

A 5-year-old boy with a fever visits Dr. Edward Volpintesta of Bethel. As he has done for 30 years, Volpintesta conducts an exam, listening to his heart and lungs, and issues a prescription. But a silent crisis is threatening the 62-year-old family physician.

Each year, it’s harder for Volpintesta to stay in business. His malpractice insurance costs $15,000. His annual salary is $75,000. That’s not a typo – it’s fairly typical for a primary care physician in Connecticut. For the record, Volpintesta plans to drive his 5-year-old Toyota until it stops running.

As lawmakers debate ways to reform Connecticut’s health care system, physicians like Volpintesta are being squeezed from all sides. Most physician offices here – 88 percent – have four or fewer doctors and total staff below 10. They are small businesses with the same concerns about overhead, benefits and the bottom line as every other small business. These practices also are our safety net and front-line defense when it comes to disease prevention and identification.

Government hasn’t done them any favors lately. Medicare reimbursements have been frozen since 2004, and a 10 percent cut is expected in 2008 – a $96 million decrease for Connecticut, according to analysts at the American Medical Association.

The situation will only get worse with the graying of our state.

Medicaid reimbursements are also so low that the Department of Social Services recently found that only one in four Medicaid patients can obtain an appointment with a physician.

Much legitimate concern is focused on Medicare and Medicaid, but the insurance industry secret is that Medicare payments to physicians are often higher than commercial insurance payments for common office visits.

The journal Physicians Practice reported in January that office-visit payments from health insurers to New England doctors dropped 27 percent in 2005-06 – the sharpest decline in the country. Five years ago, a family physician would have received $56 for that visit. Today, he receives $46. If he performed 1,500 of these evaluations a year, a physician like Volpintesta would have lost $14,600 – and that figure covers just one of hundreds of thousands of medical billing codes.

Dr. Jim Watson, a board-certified obstetrician, stopped practicing obstetrics and major surgery and went to a part-time schedule in 2006. Watson, Windham Community Hospital’s 2005 Physician of the Year, cut his hours severely to reduce his annual medical malpractice insurance premiums from $120,000 to $25,000.

Watson wants to retire, but he can’t afford to. His practice changed malpractice carriers two years ago to cut costs. Watson must carry the insurance for five years after the change, just in case of a claim. The only way he can retire is to pay his malpractice insurer close to $100,000 up front to cover the possibility of a malpractice suit.

In spite of attempts to address the problem, Connecticut remains one of 17 states on the American Medical Association’s crisis list of places where medical liability insurance rates force physicians to retire early, eliminate high-risk procedures or leave the state.

The lopsided economic realities of practicing medicine today – particularly for primary care physicians – are eroding the foundation of Connecticut’s medical community.

Over the past few years, the Connecticut State Medical Society has seen a sharp spike in the number of members retiring and leaving practice. What’s more, 30 percent of retirees told the medical society the reasons for their retirement are the financial and administrative hassles involved in running a practice.

Already in some parts of the state, patients needing certain kinds of surgery have to be airlifted to other regions because of a shortage of physicians. Among gatherings of their colleagues, Connecticut physicians describe taking out second mortgages to cover payroll while waiting for HMO payments.

In this forbidding environment, the proposal of any special new tax on physicians – no matter how seemingly small – is the equivalent of a stake through the heart, guaranteed to produce more retirements and less access to quality patient medical care.

Connecticut physicians like Drs. Volpintesta and Watson don’t want to fight with health insurers, lay off staff or turn away patients. They want to carry on the centuries-old tradition of dedication to a healthier Connecticut, in a setting where every patient has access to quality medical care in their community. Somewhere in Connecticut right now, a 5-year-old with a fever is depending on it.

Editor’s Note: This article was originally found on Courant.com, but it has been moved or deleted. We will archive it here on CG’s website.