Wednesday, September 2, 2015

Red Tape Kills Venerable Medical Practice

Bureaucratic red tape has killed a decades-old medical practice.

After 40 years of service and more than 20 years together, the physicians at Austin Internal Medicine Associates (AIMA) will be closing their doors for good Sept. 4. The physicians cited burdensome regulations ― including electronic health record (EHR) requirements and the looming switch to a new medical billing and coding system called ICD-10 ― as factors in their decision to close.

“It’s gotten a lot harder to run a small personal practice, and that’s because of all the regulatory and EHR requirements and things like ICD-10 and new HIPAA (Health Insurance Portability and Accountability Act) regulations,” AIMA physician R. Scott Ream, MD, said. “I mean, you could just go on and on about what we have to really worry about all the time.”

The four physicians of AIMA will retire after the practice closes its doors Sept. 4. From left to right: Ace Alsup, MD; Isabel Hoverman, MD; R. Scott Ream, MD; and Frank Robinson, MD. Photo by Jim Lincoln.
He and his colleagues prefer to worry about patients, not red tape. But medicine was a different profession when the doctors at AIMA began their practice four decades ago. Physicians Ace Alsup, MD; Isabel Hoverman, MD; Frank Robinson, MD; and Dr. Ream told Texas Medicine magazine being a doctor now is less about patient care and more about navigating an avalanche of health records, government technological requirements, and administrative red tape.

Admittedly, there’s more to AIMA’s closure. All four physicians are retiring, and about a year after closing the practice’s doors, three of them will be 70 years old. However, in recent years, circumstances of the modern medical landscape made AIMA’s closure inevitable.

The practice holds a meeting each year to evaluate its current situation. Dr. Hoverman says the physicians began thinking about closing AIMA last year, “But at our meeting [this year], it really became obvious that the administrative burden had really escalated even further, to the point that it had gotten just overwhelming,” she said.

One big factor was the increasing prevalence of the widely maligned EHRs.

AIMA never adopted an EHR system, citing limited resources. This year, for the first time, foregoing an EHR hurts medical practices’ Medicare bottom line. Beginning on Jan. 1, 2015, the Centers for Medicare & Medicaid Services docked Medicare physicians’ pay 1 percent for not meeting EHR requirements. That number increases to 2 percent in 2016 and 3 percent in 2017.

Another factor contributing to the physicians’ decision to retire was the federally mandated switch to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, or ICD-10, to document all patient diagnoses. Adoption is required by Oct. 1.

The Austin physicians’ concerns over ICD-10 are not unique: Nearly half of Texas doctors over age 61 might retire early due to anticipated cash-flow problems from ICD-10, according to a Texas Medical Association survey released last month.

“Of all the hassle factors, [ICD-10] is down the list a ways, but it’s definitely why we chose [Sept. 4],” Dr. Ream said.

The decision to close was a difficult one for Dr. Ream, and he told TMA’s Texas Medicine getting to know his patients is one of the aspects he will miss the most.

“They’re much more like family and friends, and that’s going to be difficult,” he said. “On the other hand, everywhere I look tells me it’s time to retire.”


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