Before the coronavirus pandemic, Dr. Andrew Bush treated up to 1,000 patients each month at his orthopedic clinic. Now he is worried about bankruptcy.
The surgeon is among a decreasing number of independent physicians in the United States, as physicians sell their practices to giant hospital systems or leave the profession altogether.
“I don’t want to give up, because I’m a fighter,” said Bush, whose clinic, Orthopedic Partners in Central Carolina, a blue-collar city serves about 30,000 people. “But our numbers in the summer were really bad. I don’t know what will happen.”
Personal safety risks and the exhaustion caused by the pandemic have played a role in some doctors’ decisions to retire or sell their offices to giant hospital systems, an outcome Bush is trying to avoid.
But some doctors and experts say the trend also highlights how billions of dollars in federal aid at the start of the crisis favored large hospital systems, even as lawmakers pledged to fight consolidation.
“The rich got richer, the poor got poorer,” said J. Bai, a professor of accounting, health management, and policy at Johns Hopkins University, who reviewed how much relief money has gone into North Carolina’s large hospital systems.
An infusion of public money has allowed big chains like Atrium Health, a regional system headquartered in Charlotte, and Duke Health, headquartered in Durham, to make bigger profits or continue with mergers.
“If you have the strength and courage to survive as an independent physician, your life will be difficult,” said Bay.
Try to stay open
Bush’s practice is in financial trouble even though he has received $300,000 in federal COVID-19 relief assistance designed to help both hospitals and small operators stay afloat. He halted most in-person visits and canceled surgeries at the start of the pandemic, fearing patients might catch the virus.
As an independent physician in a town where the poverty rate is nearly double the national average, Bush said his prospects remain bleak even as society returns to normal. About 15% of Sanford residents under the age of 65 lack health insurance, according to the U.S. Census Bureau.
Bush said patient visits have only recovered to half their pre-pandemic levels because residents are suffering from high inflation and can’t afford to go to the doctor.
according to national survey Conducted by the Physicians Foundation in 2020, an estimated 8% of physicians closed their practices in the early months of the pandemic, and an additional 4% planned to do so.
Grants, loans and other aid intended to help hospitals and doctors stay repaid have gone disproportionately to wealthy hospitals that didn’t need the money urgently like independent practices and struggling rural hospitals, according to research reports from two states and interviews with academics and doctors.
The US Department of Health and Human Services, after several requests, did not make any official available for an interview to discuss how the phantom money would be disbursed.
Despite the federal government’s reluctance to answer questions about the economic effects of the coronavirus relief distribution, some analysts said the results are visible on the ground in places like North Carolina.
a State Treasurer Report It found that seven large North Carolina hospital systems received $1.5 billion in COVID-19 relief funds while collectively seeing their funds and investments grow by $7.1 billion from 2019 to 2021.
Atrium Health, for example, has received the most money in the state, with $589 million in virus relief aid and $438 million in a type of emergency Medicare payment that boosts hospitals’ cash flow by making money up front for future services. The report found that Atrium posted a net profit of $1.7 billion in 2021 after its merger with another hospital system.
Atrium did not respond to several emails seeking comment.
‘This was a wrong choice’
Bush said the Covid relief aid helped him meet the payroll of his 13 employees. He said the aid does not cover losses from canceled surgeries and clinic visits.
Bush did not provide numbers but said his practice has not been profitable since at least 2018. At one point during the pandemic, Bush said, his practice switched to telemedicine and saw fewer than five patients a day.
Bush, 59, said he cannot retire because his practice is indebted. Bush may be willing to sell it, but he said he only received an initial offer of $200,000 from a hospital system operating statewide. This offer was eventually cancelled.
Asked if he would advise young doctors to open an independent clinic, Bush said, “Not at all.” He said the burden of fighting with insurance companies for payment and the low reimbursement rates the government pays to treat low-income patients are too much for most doctors to overcome.
About a third of the residents of Lee County, where Sanford is located, rely on Medicaid, a taxpayer-subsidized program that helps low-income people pay for health care, according to data from the state’s Medicaid Tracking Program and the Census Bureau.
“If I could go back 30 years, I wouldn’t be a doctor,” Bush said. “Looking at life, this was a wrong choice.”
Unified Health Care Systems in North Carolina
President Joe Biden has pushed the Federal Trade Commission to fight consolidation in the health care industry. in executive order Released last year, it said, “The hospital consolidation has left many areas, particularly rural communities, with inadequate or more expensive healthcare options.”
North Carolina has one of the most cohesive health care systems in the country, according to a 2021 KHN تحليل Analysis 2018 data from the Federal Agency for Healthcare Research and Quality. The analysis found that nearly three-quarters of hospitals in the state belong to a large system.
Federal and state antitrust laws are supposed to ensure that competitive markets benefit consumers. Researchers have repeatedly warned that consolidation into the healthcare industry is driving up medical costs while showing no clear evidence of improved care. a 2012 report from the Robert Wood Johnson Foundation She found that when hospitals consolidate in highly cohesive markets, price increases often exceed 20%.
The Medicare Payments Advisory Committee, which is conducting research for Congress, said in a Report 2020 Most of the markets nationwide are dominated by a single hospital system and this has led to higher prices.
The North Carolina Healthcare Association, a group that lobbies on behalf of hospitals, declined an interview request. In written responses to questions from KHN, KHN spokeswoman Cynthia Charles said the overall benefits are when hospital systems buy independent practices.
Charles said it is ensuring access to primary care in communities at a time when small practices are struggling to survive. She could not provide data on the impact of the merger on prices.
“We trust that our members are making the right decisions for their communities,” she said. Charles added that consumers should be more concerned about large commercial health insurers using market power to create obstacles to care and delay payments to medical providers.
American Medical Association 2020 Survey Results Analysis It found that for the first time since the group began tracking it, in 2012, most doctors do not work in clinics owned by doctors. The analysis cited the financial impact of the pandemic as a factor.
The loss of independent physician practices threatens to fundamentally reshape the historical relationship between physicians and patients as more physicians become indebted to their employers rather than the people they treat, said Barak Richman, a Duke University law professor who researches antitrust law and health care policy. .
Research shows that when doctors work in hospital systems, Richman said, they tend to refer patients for additional testing and more intensive treatment, which means higher profits for hospitals.
“Studies show that doctors practice differently,” he said. “You no longer have doctors competing to maintain the quality of patients.”
Bush said he had always dreamed of becoming an independent physician who would answer patients’ questions and spend time getting to know them. He has worked at Sanford long enough that he treats multiple generations of some families.
But Bush said he knew staying independent would be difficult.
He started a new focus on patients’ orthopedic care, but found that the government wouldn’t cover the full cost of the test and that many patients couldn’t afford $60 out of pocket.
“This is a poor community, the salt of the earth, and nobody cares about them,” Bush said. “If we shut down, they might have to drive 50 miles to get care. They can’t afford gas.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is one of the three major drivers in KFF (Caesar Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.