AlumniBulletin - University of Alabama at Birmingham

Physicians’ Forum
Woodard: I think cuts in reimbursement will
affect primary care physicians more than most
other specialties, since they tend to treat a
larger number of elderly and disabled
patients. I have practiced general internal
medicine in a small town for 14 years. My
Medicare percentage is about 75 percent. My
senior partner, with 36 years of practice, has a
practice that is 90 percent Medicare. We have
a large number of patients who are old and
have multiple medical problems. Many of
these people are nursing-home residents who
would have no health-care provider if not for
us. With the recent decline in the number of
medical students going into primary care residencies,
coupled with an aging population, I
fear there won’t be enough providers available
to care for the Medicare population in the
next 10 to 15 years.
The White House recently approved additional
options in the Medicare+Choice
plan, which will be modeled after privatesector
preferred provider organization
(PPO) coverage. To what extent do you
expect that this measure will make health
care—particularly drug prescriptions—
more accessible to seniors who cannot
afford supplemental insurance?
Woodard: I think this will help initially.
However, as the general population continues
to age, and as medical technology continues
to expand the number of costly medications,
I don’t see the proposed change lasting very
long. The responsibility for the increase in
pharmaceutical costs involves all of us. The
increase in class-action suits does nothing
except drive up drug costs. The drug companies
need to recoup the costs of drug development,
but it seems their marketing and sales
costs could be reduced, with those cost savings
passed on to the consumer. Another big
part of the increase in drug costs falls on the
shoulders of physicians themelves. As a group
we tend to use the newest and most expensive
medications available. I am certain that many
minor infections, dyspepsia, arthritis symptoms,
and even cases of hypertension could be
treated with older, less-expensive medications.
Speir: With the Medicare+Choice plan,
patients who can afford supplemental insurance
will be able to obtain limited help with
certain drug prescriptions. Many are finding
that this costs as much as, or more than,
their prescriptions.
“Another big part of the increase in drug costs falls on the shoulders
of physicians themelves. As a group we tend to use the newest and
most expensive medications available.” —James Woodard, M.D.
Estimates of physicians’ ability to increase
productivity were a key issue in the recent
proposal to reduce Medicare cuts. In
what ways, if any, do you expect that
physicians will be able to reduce their
expenses in order to make up for reductions
in reimbursement?
Speir: Medicare is giving many physicians only
two options: Offer substandard care, which
most refuse to do, or refuse to see Medicare
patients at all, which has become the least
undesirable alternative. There is no incentive
for physicians to reduce expenses, or withhold
services from their Medicare patients, except
the threat of prosecution or liability for delivering
only the degree of service commensurate
with the price being offered. Physicians have
negative incentives to see Medicare patients
and do so only out of compassion and concern
for their patients and community.
Woodard: As part of a practice in a small
town, with at least 75 percent Medicare and
an office overhead of 50-55 percent, I don’t
think I can increase my productivity much
more with regard to Medicare patients. It boils
down to deciding whether you’re willing to
make less salary in order to see these patients.
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Are there any other steps that physicians
can take to still provide necessary services
to patients whose coverage has been cut?
Woodard: The use of physician extenders
(nurse practicioners and physician assistants)
would be one way.
Speir: There are many solutions to the financing
problems faced by Medicare. Withholding
monies from physicians and other providers
will lead to the worst outcomes. As I have
mentioned, there are no positive incentives for
physicians and other providers to continue to
subsidize the Medicare program. There are
only undesirable options for physicians, and
the ever-increasing risk of prosecution or liability
for unfavorable outcomes.
Private pay and a few adequately insured
patients have subsidized the care of indigent,
underinsured, and Medicare patients for
years. This ever-smaller group of adequatepay
patients can no longer carry the burden.
It is no longer a viable system.
Give seniors a real choice. Give them money
or a voucher equal to the fair value of the cost
of a senior’s care, and allow them to purchase
their own health insurance. Let the open market
compete for their business. Eliminate age
discrimination in the health-insurance business.
Give seniors at least the same rights and
options as the rest of the population. Relieve
physicians and other health-care providers of
the default position of becoming financiers of
last resort for seniors with Medicare.
I am closing my practice. Many excellent
physicians will do the same, as soon as they can.
They will return only when the current punitive
“Medicare is giving many physicians only two options: Offer substandard
care, which most refuse to do, or refuse to see Medicare
patients at all, which has become the least undesirable alternative.”
—Betty Ruth Speir, M.D.
system has been fixed. I hope that will occur
soon. This generation of seniors continues to
suffer the consequences of a broken system.