Small town USA Family Doctors - Becoming Extinct?

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I located a couple articles which will give some light as to why I am writing this letter to each of you.

I want this to get out and around so that perhaps some way some how another “Small Town USA Family Doctor” doesn’t take down his/her shingle before their time.

Shortage of Doctors Affects Rural U.S.
By CHRIS TALBOTT
The A$sociated Press
Sunday, July 22, 2007; 2:58AM



Help Wanted: More Doctors for the United States
Posted 6/24/2005Jordan J. Cohen, MDAuthors and Disclosures Published: 06/24/2005


My reason for bringing this to light is due to our doctor’s appointment last evening, May 28, 2009. You see our family doctor is located in a small community 20 miles outside of Dayton, Ohio. Yes, my husband and I live in Dayton and yes we do travel that far and our main reasons are when we NEED to see a doctor we became frustrated with the response from the physicians within the Dayton area. One of us would be really ill and call to see the Doctor and were told to go to an emergency facility because the Doctor CANNOT see you for at least two weeks.

Perhaps this is why the Emergency Rooms are way overloaded. Did anybody ever think about that?

Our family doctor opened her office in 1999 and we first started seeing her in July of 2000. Ever since that time whenever one of us were ill, not the sniffles, we would call and they would be able to fit us into their schedule. AMAZING isn’t it in today’s hustle bustle world. Sure it takes us nearly an hour to drive over to see her but so what! We have had excellent care under her and there is no way that I would ever intentionally change physicians. So you see this is why my husband and I became upset and quite angry last evening.

I especially liked the article I linked above concerning the prediction as to how many doctors our country will need as the “workforce” is aging, that includes family doctors. So just who will be treating us “baby-boomers” which includes me and my husband?

Our family Physician sat in the exam room with my husband and me Thursday evening and told us about the dilemma she is facing right now. Our doctor is facing foreclosure of her medical office building. No it is not because of misappropriation of funds. No it is not because she insisted on a “swanky” over the top office facility. No it is not because she and her staff didn’t care. No it is not because she is of Middle-Eastern descent as within the article I posted. Heck I knew her grandparents and parents! Her office is located within the small village I grew up in.

The reason is on the backs of the insurance companies and especially MEDICARE! Yep that is right MEDICARE is the biggest culprit in this disaster. There are bills unpaid to her practice from 2006 and the grand total due from Medicare is well over $200,000.00. Or course I typed that correctly and I do not mind telling you when she told us that last evening my jaw hit the floor. What in the heck is going on in Washington?

Sure some of you will blame our current Administration President Obama but get real. This was going on way before he was even considered a possible candidate. This was going on during the Bush Administration and during the Clinton Administration. Perhaps President Clinton and Hillary were correct in the 1990’s about a national healthcare then again with what I have found out well maybe big government is not the answer after all.

The United States has such a shortage of Medical professionals willing to forgo the “big bucks” they can earn in a specialized field. When a Physician wants to establish an office in a small community it is a crying shame that they may have to close because our government cannot get their act together enough to pay what is rightfully due to them.

Here is another part of this story. The home town I grew up in and where her office is located did not have “fast internet” capabilities until recently. They only had DIAL UP until last summer. Sure this is 2009 and well last year was 2008. I have not used dial up in years.

Why am I adding this to the story? Well Medicare wanted to have all medical facilities upload all the claim records starting in 2006. Any office with more than 10 employees it was a requirement, no if ands or buts about it. Our Physician only employ’s 5 yes that is one half of the requirement therefore her office could continue to paper file forms. She was having problems and after several “calls” to the Medicare claims department she was informed that she would need to fill out a form to claim exemption from “internet” filing. Well she did and she did this more than once because Medicare did receive the first form but it was logged into their system in the wrong area and well they could not just pull it out and move it over. NO they wanted another form filled out and mailed. Just the first part took 90 days before she found out she had to resend in the form. Then she had to wait another 90 days to find out that okay they had it.

Since 2006 she has had time and time again all the “claims” returned to her for various reasons. The best one was the “decimal” was not centered in the block. Many of you understand when you fill out your deposit slip for the bank there may be “10 blocks” in which you enter the dollars and cents you are depositing and a decimal in the middle. Well the decimal on ONE FORM was too close to the “side/line” of the block. GIVE ME A BREAK that is the most ridiculous reason I have ever in my life heard.

They would make the corrections and call the Medicare claim department before returning the corrected form and ask the most important question, WAS THERE ANYTHING ELSE? Time and time again the individual at Medicare, first name only and never the same one twice, would assure them that “yes that is the only reason the claims were returned”.

It took what I consider an act of God to get any bit of money out of Medicare last year, 2008, on claims filed in and since 2006.Congressman John Boehner, 8th District. Our Physician had contacted his office since she is within his district. He sent a letter to the Medicare claims office and the letter in reply was rather curt, okay let’s just say they told him that since he was in the “legislative” branch and they were in the “executive” branch of the government he could go away or how I like to say it “take a flying leap”.

No wonder nothing gets accomplished in Washington. Left hand will not cooperate with the right hand. Kind of reminds me of how the Republicans and Democrats work together.

Okay back to my story, after Congressman Boehner received the letter he contacted our Physician and not only informed her of the reply he received he even sent her a copy. Anyway shortly after our Physician contacted Congressman Boehner again and informed them that the bank was starting foreclosure proceedings. Once again Congressman Boehner contacted Medicare and well SURPRISE a check was issued for a small part of the 2006 claims, just over $21,000.00. What is that 10% of what is due to her office? At least it was something but not enough.

The bank has started foreclosure and it seems that nothing is going to stop it. There was a light at the end of this tunnel, the hospital our Physician is associated with contacted the bank and offered to help with the “building debt” in order to keep her in the community. The bank has yet to respond to the hospital. Kind of frightening as to how the banking industry is working, a “well known” local Hospital has made an offer to “free up” a debt owed and the bank is refusing to take their money!

So now Washington DC I wonder who will be the “Knight in Shinning Armor" and correct what is wrong. You can keep dumping dollar after dollar to save the banks and they will not help themselves when someone tosses them a life vest. While we the taxpayers will continue to pay our taxes while one of the largest “money pits” Medicare will continue to drive our small town physicians out of business. No wonder many physicians prefer to join a “corporation” after all if you don’t have your own “bank” you sure can’t have your own medical practice.

My plan now is to send this to Congressman Mike Turner as well as Senator Sharrod Brown perhaps some of you would join in and help. Yes I am asking for help to see that "Small Town USA Family Doctors" do not become extinct.

[dipsydoodle]

1. If you use the anology of the UK

in the overall desire for you to have single payer in the hope things will imoprove - our doctors are not employed by our NHS : they are paid for the work they do on behalf of the NHS. They actuall yhave no obligation, other than moral, to do any NHS work at all. Some literally may only do private work and that is nothing to do with insurance companies as broadly speaking referals for insured treatment commence with an NHS doctor.

Doctors tend to use limits for the patients on their books with preference given to locals - so, travel may often become necessary. This is even more so with dentists for NHS treatment where travel of 20 miles or so might be considered insignificant by some.

Notwithstanding the fact Dayton is a big place if by any chance you know Chaz and Linda then please say hello for me.

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2. I don't believe that just a prayer will work in this case

Dipsydoodle, Thank you for taking the time to read what I posted as well as reply. Also sorry I do not know a Chaz and Linda but if I did I definitely would give them a big hello from you.

[Aragorn]

3. Sad but not uncommon

Medicare and Medicaid usually contract to some third party for claims payments. The problem as you describe it is one way they (unlike most private insurers) have used to avoid paying claims rightfully submitted. They also mis-use statistics, etc etc to hassle providers, although it is a misguided way to look for fraud. I could go on and on. I have never had problems as bad as you describe though, but it is certainly due to the typical response from Medicare and Medicaid.

While it may be obvious I think it is worth pointing out that a rural doctor or similar rural provider is more dependent on Medicare/Medicaid for payment that an urban provider, usually.

If your doctor there has not done so already she needs to pursue a couple of other routes. She can hire a claims specialist, but needs to make sure it is someone who actually has succeeded, not someone who claims (pun intended) to know how to fix this. There are also ways Medicare has outlined for redress within their own system. Obviously both approaches may move towards the latter. Neither one is likely to be fast.

It was not good business to let it get so far out of control before pursuing this.

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4. It is something that should not be happening.

One thing that I found interesting is when Congressman John Boehnner contacted Medicare by phone he asked to speak to a supervisor. Well that didn't happen and then guess what? There is no physical address to which the Congressman could go and speak in person to someone anyone concerning this. What gives with that!

You are also correct this should not have gone on this long. Before 2006 they did not have anyway near the problems they have experienced since Medicare decided the Medical facilities needed to file claims online. Her office is exempt because she is a one doctor office with only two full time and one part time employees.

Then she would call and call and she was assured that everything on the recent mailed in claims submitted were correct. A couple weeks later she would receive in the mail the claims she had been assured were correct back for something else. THAT is what has become very frustrating.

They never speak with the same person and that person only gives their first name and never a phone number in which they could be reached. Talk about a "secret club" mentality going on within this department.

Because of this she has taken a second job. Her office at one time was open every Saturday now it is only open one Saturday a month and the other Saturday's she works for someone else. She also works a couple evenings a week and her husband has taken on a second job this is necessary so they can keep their home.

The office she has was a house that in 1999 she purchased and set up her medical practice in it. The town, or village, she is located in has fewer than 1900 residents and is the town I grew up in. My 90 year old mother lives the second street over from the office.

The community will suffer greatly if she does close up shop and move in with another physician and this would be in another town since she is one of 3 physicians in the whole county.

[TheMightyFavog]

5. Didn't there used to be a program...

That wiped out a significant chink of a new doctor's student loan debt in exchange for setting up a family prctice in undeserved rural communities?

IIRC, Reagan axed it in the 80s

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6. loan forgiveness

The programs are out there whether she fits into their "forgive" factor or not?

Since she wanted to establish her practice in the village she grew up in could have been a factor in her not being eligible. I do know that when her Grandmother passed away our Doctor inherited a sum of cash which was to be used for her college education and toward her medical degree. Therefore perhaps she did not have a "student loan" only a loan required to purchase the building as well as the equipment needed.

Before she opened her office she was the talk of the town how she her husband and her brother-in-law were totally changing the layout of the house. They did the work themselves and did a pretty good job if I may say so.

Her brother-in-law also keeps their computers up and running, he is their tech-no geek, and we all know the cost of keeping several computers linked and running and protected and secure.

This link delves into more detail as to how these loans are "forgiven". In some instances doctors are requested to work in a designated area and since she wanted to return to her home town well.....

http://nhsc.hrsa.gov/