Janet Grossman is taking it easy these days. Simply climbing a few stairs leaves the Sag Harbor retired schoolteacher out of breath, because although the 66-year-old won her battle against Stage-III ovarian cancer two years ago, she is still in pain and it’s difficult for her to move.
Now, she has an additional fear: She is terrified at the prospect of losing her doctor. She says she owes her life to the staff at Long Island Gynecologic Oncologists (LIGO). The Smithtown practice specializes in treating ovarian and other gynecologic cancers, and she emphasizes that she is eternally grateful for its outstanding, caring doctors. But she is troubled about her lifesavers’ future. Driving to Smithtown for care has been hard, but she may face a longer drive. LIGO is being “forced” to close, says Grossman, because it can’t afford to stay open at its Smithtown and Mineola locations. She doesn’t know if her gynecologic oncologist, Dr. Michael Pearl, will relocate too far away for her to continue treatment.
“It’s really sad, and scary. I could lose my doctor. I would be horrified,” says Grossman.
Like many LI businesses decimated by the 2008 econ-ocalypse, physicians, too, are susceptible, with many shutting down. Rising malpractice insurance premiums and slow or poor Medicare insurance reimbursement are the usual culprits.
What does this mean for those who are sick, for our expectant mothers, our children?
Khrissy Lupinacci, founder of Long Island Ovarian Cancer Education Advocacy Network & Support (LI Oceans), believes that limited coverage will have devastating effects.
“It’s awful, but unfortunately I foresee more women are going to be dying here on Long Island because they are not getting proper care,” says Lupinacci.
Pay The Doctor Last
Years ago, becoming a doctor was a straight path to financial comfort. Many thought of healthcare as recession proof: Think how often you’ve heard, “Even when there’s no money people will still get sick.” But today, it’s increasingly difficult for LI doctors to practice medicine.
A November 2008 report from The Physicians’ Foundation says that nearly half the nation’s practicing primary care physicians—more than 150,000—will stop practicing or reduce the number of patients seen. The reasons for dissatisfaction among primary care physicians, once referred to as general practice or family doctors, include “increased time dealing with nonclinical paperwork, difficulty receiving reimbursement and burdensome government regulations.”
Doctors are fleeing LI or giving up practices, often because of overwhelming and ever-increasing malpractice costs and ever-decreasing reimbursements, all resulting from health insurance company policies. The premiums malpractice insurers charge physicians keep increasing to keep pace with the enormous awards lawyers often seek, through settlement or a jury trial. Doctors’ malpractice insurance premiums may climb as high as $250,000 annually, nearly double the rates charged in 2003. At the same time, doctors are paid less for services because of Medicare reimbursement reductions; other insurance companies follow suit.
“It is economically unfeasible for us to stay in business,” says Dayna McCauley, Pharm.D., LIGO practice administrator. Seeing no end in sight, she echoes the words heard nationwide—things will get worse before they get better—and says, “2009 will potentially be worse than 2008, and you’ll see more practices, like ours, closing.”
Many predict that for the short term, patients will crowd the remaining doctors’ offices, wait longer and possibly pay more.
“Coverage will indeed be limited,” says McCauley. She explains that skyrocketing malpractice insurance costs have been tearing LIGO apart. That, coupled with poor reimbursement policies, dealt the final hand. Globally, reimbursements from managed care companies for services keep decreasing, she adds. The reduced amounts paid back to physicians do not cover the costs of their services.
“The big change was in chemotherapy services,” says McCauley. “The model results in chemotherapy service reimbursement being equal to or less than what it costs the provider to get the drugs in practice.”
This leaves no margin to sustain significant losses on surgery, office visits, and office procedures.
“Malpractice rates have gone up tremendously, for all doctors, but it is astronomical for doctors that deliver children or deal with cancer patients,” says Sandy Rich, president of LI Oceans and an ovarian cancer survivor. “The doctors do all they can to save the patients—only 20 percent of ovarian cancer cases survive. The odds are stacked against the doctor and the patient, so a series of lawsuits and rising malpractice insurance puts us at a loss. It’s a great tragedy.”
LIGO’s physicians will relocate to three hospitals, and their patients will follow—if the doctors stay nearby, and if the patient’s insurance covers wherever that doctor moves to.
It’s not just LIGO that’s affected: This is an Island-wide—and nationwide—problem. Garden City infertility specialist Dr. Jeffrey Braverman knows firsthand that it’s not just gynecological oncologists paying the price of rising malpractice insurance premiums and poor reimbursement.
“The main specialties hit the hardest are obstetric, orthopedic and neurosurgery,” says Braverman. “Because the payout for malpractice suits is the highest in those fields, they have the highest premiums.”
One Hampton Bays gynecologist, Dr. Geri Schmitt, says she gave up obstetrics in 2003 because the escalating malpractice premiums were so “outrageous” and the reimbursement so poor. And while she’s never had an obstetrical lawsuit, her premiums were so high that it was not only not profitable for her to continue to deliver babies, but almost impossible.
“Just to cover your premiums with what they reimburse you requires you to do upwards of 60 deliveries a year, and that just covers your premiums for malpractice. You still haven’t paid your lighting bill, your nurse, your salary, your rent, or anything else,” says Schmitt.
Braverman, too, was once an OB/GYN in private practice. Because he became busy with his infertility practice, he had time to perform only a few deliveries. He was paying high malpractice premiums, so it was no longer cost effective for him to continue delivering babies. He transferred his obstetrical volume to a group focusing on deliveries, to concentrate on his infertility practice—where malpractice premiums are significantly lower. He is currently medical director of the Sher Institutes for Reproductive Medicine (SIRM-LI) in Woodbury.
“I loved doing deliveries. I loved being with my patients,” remembers Braverman.
He explains the realities of obstetrics today: Trial lawyers go after doctors with botched deliveries, suing for any amount they deem necessary: If a jury sides with the plaintiff, the malpractice insurance company pays. Like Schmitt, even doctors who’ve never been sued have to pay exorbitant premiums, just in case. Sometimes companies advise the doctors they insure to settle, because a settlement costs less than a legal defense. This way, the malpractice companies can conserve funds, for larger payouts. The No. 1 leading reason for malpractice suits is cerebral palsy, or any other neurologic injury that may have resulted during delivery.
“Roughly 5 percent of obstetricians’ deliveries will have a complication,” adds Braverman. “It is so difficult for a busy OB/GYN to prepare his medical chart in such a fashion that will withstand a vigorous trial by well-prepared attorneys that even when there’s no negligence in the part of the doctor, it’s still difficult to convince a jury of this.”
Left In The Dark
Pregnant women with no doctor to care for them or deliver their babies. Cancer patients being denied important screenings and treatments by insurance companies. These are possible long-term consequences of the current doctor drain. But it’s not just obstetricians and oncologists who find it difficult to stay afloat: LI specialists in other medical fields are being edged out.
Karl Grossman, a journalism professor at SUNY Old Westbury and chief investigative reporter for WVVH-TV, Hamptons Television, is also married to Janet Grossman, the ovarian cancer survivor mentioned earlier. When he learned about his wife’s doctors’ situation, he was outraged, and began working on a piece about this predicament: “Medical Care Crisis.” He didn’t need to look far to realize that this is indeed a crisis. He says that his own Sag Harbor primary care physician, Dr. Robert Semlear, was moving his practice upstate to Hudson. The reasons: the high costs of having a practice on the East End plus low insurance reimbursement (Semlear gets less reimbursement because Sag Harbor is considered a rural area) and high malpractice premiums.
“I was just flabbergasted to find that doctors are in trouble everywhere,” says the reporter, who, like nearly everyone, attributes the problems to the ailing healthcare system and insurance companies.
“They are like the thieves on Wall Street, only it is worse. This isn’t paper—it is blood money, this is people’s health they’re dealing with. It’s evil to deny people care,” says Grossman.
In addition to shortsighted insurance companies’ policies that deny care, there is also the reality of the high rates charged by those companies that drive doctors away. Louis Atman suffers from dementia; the 84-year-old Merrick resident is essentially incapacitated. Atman’s grandson, Arthur, takes care of him when he can, but because his grandfather needs constant supervision, he has a live-in aide. But last year, Atman’s primary care physician, Dr. Robert Smith, had to say goodbye to the frail old man and his other patients, when he sold his practice and started fresh in Denver, Colo. The doctor cited LI’s high cost of living and “exorbitant” malpractice costs as the final straw, says Arthur.
Arthur says that his grandfather really suffered when Dr. Smith left. “He’s old and set in his ways, and he really liked Dr. Smith,” says Arthur, adding that it’s especially hard to find doctors who make house calls, as Smith did.
“His new doctors aren’t as helpful, and the doctor doesn’t come to the house, but sends a nurse practitioner.” And while Arthur is grateful for his grandfather’s new doctor (whom Arthur chooses not to name), he feels that his grandfather is not getting the high quality of care he received from Dr. Smith.
THE SOURCE OF THE INFECTION
If you ask 25 people what the problem is, you’ll likely get 25 different answers. But in this case, each doctor and patient names the same causes of the problem: high malpractice insurance costs; low, slow reimbursement pay; health maintenance organizations (HMOs) that make it increasingly difficult to treat patients because of refusals to approve procedures and medications.
One LI doctor, who asked to remain anonymous to avoid becoming a victim of retribution, blames overzealous trial attorneys. “There’s this fervor to sue. Every OB/GYN will have a lawsuit, it’s just common,” he says. “If you settle those lawsuits, you are afraid of a disbursement that goes on your record. When you have enough of these [disbursements] your malpractice insurance will raise the premium, double, or be thrown out altogether.”
This physician says that the safest thing an obstetrician can do is go to trial and hope to win, but the damages are so extreme and the time away from the practice so damaging that no doctor can afford that.
Bryan L. Salamone, Esq., points out that “95 percent of all medical malpractice cases are not real malpractice, but are just bad results after appropriate medical treatment.” Salamone is with a firm whose clients included PRI Physicians Reciprocal Insurer, MLM Medical Liability Mutual and large well-known self-insured hospital.
Responding to nationwide pressures forcing doctors out of practice, the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) community affiliate Working America launched “In the Heart of the Health Care Hustle,” in March 2007, a campaign pinpointing those they blame for our broken healthcare system: they cite the “Greedy Corporations,” “Big Pharma,” the “Insurance Industry,” and “Bush & Co.”
As part of the campaign, the Working America website details how these and other entities are profiting from rising healthcare costs—and, consequently, leaving patients—and doctors in practices such as LIGO—to fend for themselves.
The unnamed physician sums it up, saying, “For most, there is just no way to win. The only way to win is to close your doors—then really, nobody wins. Not the doctor, not the patient.”
The Prognosis
What can be done? Some are optimistic, some not.
“I certainly don’t have any confidence that a massive overhaul in the healthcare system will be financially sustainable,” says LIGO’s McCauley. “The problem is a national problem, acutely worse on LI because cost of living is very high, and premiums are out of control. But it’s a national problem.”
McCauley insists that patients need to lobby elected officials and tell them that in New York State, what’s badly needed is tort reform. This buzz term permeates the healthcare landscape. Each doctor the Press spoke to, hands down, said that tort reform is the only answer.
Designed as fixes for our ailing legal system, tort reforms seek to improve and correct the way people seek compensation for wrongful injuries or damages suffered. “Tort reform, or malpractice liability reform, is a [rewrite] of the [state] laws regarding how malpractice cases are tried and settled,” explains Braverman.
Besides tort reform—which many doctors envision as unattainable, other solutions have been toyed with in New York State, to address the disappearing doctor problem. Salamone, the attorney, disagrees with one proposal: capping the amount of compensation for damages suffered.
“There should be no caps because attorneys are forced to wait years to receive compensation for cases that are contingent on winning the case, an attorney can have 100 cases and spend $20,000 on 100 cases for a total of 2 million dollars, and not receive any money for the first two years. And only a small fraction can result in a win. Attorneys only get paid if the case wins,” says Salamone.
In September 2008, Gov. David Paterson signed into law a bill freezing medical malpractice rates statewide until July 1, 2009, giving state officials and policymakers more time to agree on how to reduce rates.
While some herald the move, the moratorium on raising medical malpractice rates gives little hope to centers like LIGO, which will cease to do business as of Dec. 31.
McCauley is skeptical, saying, “I certainly don’t have any confidence a massive overhaul in the healthcare system will be financially sustainable.
“Right this very second, all patients can do is everything they can to try and keep themselves healthy and out of the healthcare system,” she adds. “All of the problems we are facing as a community, anything people can do to improve general health status, is in their best interest. You can’t control your genetics, but you can control wearing a seatbelt, smoking, drinking and weight loss. It’s going to get worse—everyone should be protecting themselves to stay out of the [healthcare] system.”