Sunday, February 17, 2013

From the Rio Grande Valley … “A Cry for Help!”

The following is a letter by McAllen neurologist Miguel A. Gutierrez, MD, PA. In the letter, Dr. Gutierrez describes the red tape, government bureaucracy, and low payment from Medicare and Medicaid forcing his medical practice to the brink.

To Whom It May Concern:

My name is Miguel A. Gutierrez, MD, neurologist. After being a professor at the Universidad de Medicina in Mexico and a neurologist for 13 years, my wife and I made the difficult decision to leave our home in a nation whose government had no idea how to best manage the country’s health care. A country that left us powerless to help patients, and many times left us facing the moral dilemma on how to help patients without having to pay their health care out of our own pockets.

My wife, being a citizen of the United States of America, convinced me to move to the U.S. and start a new life with our three children. Our idea was that this country, being a first world country, had better resources. I would have to pass exams in order to continue to practice medicine, but my efforts would be rewarded by being able to practice medicine in a country where I could help the community by providing better diagnostics and medications. Once I passed the required exams we moved to Arkansas, where I did one year residency in internal medicine and three in neurology. After this, we moved back to be closer to my wife’s family.

I established my practice as a neurologist in the Rio Grande Valley from the ground up. I opened the doors to my practice in McAllen, Texas, an area with high incidences of Medicare and Medicaid. The area is home to many retired individuals, who have worked all of their lives and now have Medicare. It is also home to a large population who lives in poverty and relies on Medicaid for health care. It is with great sadness, however, that we now find history repeating itself. Our government dictates what medication I can prescribe, without taking into account what is best for the patients. Our government has reached a point where health care is not determined by the necessities of patients, rather it prefers to save money by demanding the use of cheaper pharmaceuticals, lowering payments for services rendered, and endlessly requiring documentation supporting established health care practices. This has, in turn, increased our overhead and decreased our revenue to a point where we find ourselves having to cut benefits and personnel. Now we have contributed to a vicious cycle, where our own employees in the health care field do not have health care coverage but would in the unemployment line if we are forced to close our doors.

This bureaucracy has caused area physicians to either close their doors or move their practice to communities with lower volumes of patients with Medicare and Medicaid. The Medicare incentive program, Health Physician Shortage Area, was terminated and affected our income. Also the nerve conduction study, which is needed for a better diagnosis, was cut by more than 30 percent. At 61 years of age, I find myself constantly evaluating my practice. How am I to continue to provide medical care to a community when I find myself regularly taking out loans to support my practice? Our area has a shortage of neurologists, and logically no one wants to come to a poorly paid area. In the billing department there are more obstacles for reimbursement of services that have already been rendered. With an incredible amount of patients, I find myself working more for less. I am a physician, a specialist, whose biggest worries should be to provide the best possible care to my patients. I should be focused on keeping with the latest innovations in patient care. Yet, at the end of the day, my biggest worry and focus is keeping up with our country’s cuts to health care.

It seems that our government is fixated on punishing those who choose higher education and work the hardest. Our government’s focus should be on identifying and reducing health care fraud, no limiting honest and hardworking physicians.

I ask that our representatives take our cry for help to Congress, and provide viable solutions before we reach a greater crisis. If we continue at this pace, health care provider shortages will continue to be catastrophic to our communities.

Respectfully Yours,

Miguel, A. Gutierrez, MD

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