PSN partners with rural hospitals to provide an infrastructure to support the rheumatologist. He notes, and Dr. Kolba agrees, that many of the changes brought about by healthcare reform are burdening physicians, cutting into their productivity and ability to care for patients. When it is possible to relieve some of these burdens, it becomes easier to get people to rural areas.
Medicare Changes Death Knell for Small Practices?
Dr. Kolba thinks that changes in Medicare reimbursement coming in 2017 may end up being the death knell for the small group practitioner. Practice modifiers for quality will determine whether a practice gets a bonus or has to pay a penalty. The problem is that there seems to be no consensus on what the indicators are and how they will be implemented.
“I can tell you for sure that if these changes go into effect, I will retire,” she says. “It is set up as a zero-sum game, so for everyone [who] gets a bonus, there has to be someone who is penalized. I see that as a completely untenable way to practice, because you have no way of knowing how the Centers for Medicare and Medicaid Services is going to make [its] judgments, so you risk a haircut that you can’t plan for.”
Dr. Kolba is not sure about the viability of solo or small group models going forward.
“I think many of the changes are going to finish off a lot of us solo or small practices,” she says. “This is more of a feeling than anything, but it seems most of the new grads are expecting to be employees and don’t want to run their own practices. It is an interesting change in the mentality and outlook of many doctors to not even consider doing things on your own.”
Things are not all bad.
The ACA added insured people to the rolls, meaning those that may not have been able to see a rheumatologist before now have the resources. For many physicians, at least as important a consideration is that more of their patients can afford medications and be treated to standards of care.
In those states with expanded Medicaid—an important component of the payment structure in rural healthcare—additional reimbursement opportunities are available.
“In my state, MediCal payments were equalized with Medicare for specialties like rheumatology, with a high level of Evaluation and Management codes,” says Dr. Kolba. “So instead of being paid $10, the state pays me $75.”
Impact of Hospital Closures
Another consequence of reform has resulted in an increase in the closures of rural hospitals. Because rheumatologists aren’t heavy users of inpatient services, they may actually be better able to stay involved with their communities.
