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Appalachia Health News tells the story of our health challenges and how we overcome them throughout the region. 

Private Practice Doctors Struggle To Stay Open

Kara Lofton
West Virginia Public Broadcasting
Doctor Elizabeth Brown in her South Charleston office.

Elizabeth Brown, M.D., operates a small, thriving private practice in South Charleston. “Most doctors want to practice, that’s why we went into medicine,” she said in a recent interview.

But being in private practice isn’t easy. Across America, doctors are leaving private practice in droves, citing reimbursement challenges and greater overhead costs. For some, staying means deciding to not take certain insurances.

“Medicaid particularly is a very labor-intensive insurance to take,” she said. “Because if you want a test scheduled, you have to go through their online portal, and it can take upwards of two hours to schedule a test for a patient.”

Dropping Medicaid is one of several strategic decisions she has had to make over the past 12 years or so in order to keep her practice open.

“If you employ a lot of staff and if you have multiple physicians in that practice, you might be able to hire enough people to do that,” said Brown. “For those of us who are small practices, you can’t afford to do that. You can actually utilize your time so much better taking care of many other patients with other insurance than you can for, say, Medicaid.”

A couple years ago, Medicaid began to require that physicians meet certain “quality measures.” These are supposed to keep track of how well a patient is actually doing under that doctor’s care. It’s all tied to the patient’s electronic medical record. But here’s the thing. Some patient outcomes a doctor can’t control, like how often a patient takes their medication, or signs into the online patient portal. These factors factor into how much the doctor gets paid by Medicaid, though. Oh, and by the way, that electronic medical record the doctor is now required to use can cost them up to $160,000 to install.

“I was able to meet all those measures for the first four years that they were implemented,” said Brown. “But they’ve become so stringent that unless you have a big team of people actually just dedicated to helping you do data reporting, I just can’t do it.”

Brown said she even hired an extra person last year just to manage the paperwork, and she still wasn’t able to keep up with it. So she stopped taking Medicaid. And she’s not alone. About 25 percent of physicians who responded to an Accenture survey in 2015 said they were opting out of taking Medicaid.

But some private practice doctors say they can’t afford not to take Medicaid.

“For this office, we are one physician, one, two, three, four and a half employees, and it takes $30,000 a month to break even. That’s to break even,” said Chad Brown, office manager and husband of Kate Brown, D.O., of Brown Family Practice in Wheeling. (No relation to Doctor Elizabeth Brown in South Charleston.)  The Wheeling Brown Family Practice is fairly new – they’ve only been around five or so years – and they say right now it’s about all they can do to survive.

“As a physician’s office, you know you will be paid by Medicaid, but you may not necessarily get paid by your patient because of their deductible,” said Chad Brown.

He’s referring to the fact that some patients who bought health insurance through the Affordable Care Act have such high deductibles that when they go to the doctor they have to pay a lot out of pocket. Which means sometimes they don’t pay at all. At least with Medicaid, even though it doesn’t reimburse well, the physician gets paid something. But we’ll talk more about high deductibles in a later story.

Why should you care, if doctors like the Browns are deciding not to take Medicaid? Well, if you happen to be part of the third of West Virginians that have Medicaid, it’s going to limit your choice.

“I hear the frustration in these people’s voices every time they talk to my staff and find yet another doctor that doesn’t participate,” said Elizabeth Brown.

It is worth noting that doctors in Federally Qualified Health Centers do take Medicaid (it’s one of the requirements of being an FQHC), as well as physicians like the Browns in Wheeling. On the other hand, many specialists do not.

Elizabeth Brown said she would consider taking Medicaid again if processing it became easier. But for now, it’s not. And unless the system changes, not taking Medicaid may mean simply this: she can keep her doors open. She can stay in business as an independent family practitioner.


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