SANFORD, NC – Before the coronavirus pandemic, Dr. Andrew Bush treated 1,000 patients a month in his chiropractic practice. Now he’s worried about bankruptcy.
Surgeons are one of the few independent physicians in the United States where doctors are either selling their practice to giant hospital systems or leaving the profession altogether.
Bush, who practices the Central Carolina Orthopedic Association, which serves a blue-collar town of about 30,000 people, says, “I didn’t want to give up, because I was a boxer. “But our summer numbers are terrible. I don’t know what will happen.”
Personal safety risks and pandemic fatigue have played a role in some doctors’ decisions to retire or sell offices to giant hospital systems, an outcome that Bush trying to stop.
But some doctors and experts say the trend also underscores how billions of dollars in federal aid at the start of the crisis favored major hospital systems, even as lawmakers declared to oppose the merger.
“The rich get richer and richer,” said Ge Bai, a professor of accounting, health and policy management at Johns Hopkins University who has looked at how much relief money has gone to major North Carolina hospital systems. and the poor get poorer.
Public funding allows large chains like Atrium Health, a regional system based in Charlotte, and Duke Health, based in Durham, to either reap larger profits or continue pursuing a merger.
Bush’s job was financially problematic even though he received $300,000 in federal tubal relief aid meant to help both hospitals and small operators stay afloat. He halted most in-person visits and canceled surgeries at the start of the pandemic, concerned that patients could contract the virus.
As an independent physician in a town where the poverty rate is nearly double the national average, Bush said his outlook remains dire even as society returns to normal. About 15% of Sanford residents under the age of 65 lack health insurance, according to the US Census Bureau.
Bush said that patient care is only half of its pre-pandemic level because people are struggling with high inflation and can’t afford to go to the doctor.
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According to a nationwide survey conducted by the Physicians Organization in 2020, an estimated 8% of doctors closed their practice in the early months of the pandemic, and an additional 4% plan to do so.
According to research reports from two states and interviews with academics and doctors.
The US Department of Health and Human Services, after repeated requests, did not allow any officials to come for an interview to discuss how the funds were to be disbursed.
Although the federal government is reluctant to answer questions about the economic impact of fish-meter relief distribution, some analysts say the results are visible in places like North Carolina.
A state treasurer’s report found that seven major North Carolina hospital systems received $1.5 billion in covid relief while their cash and investments increased by $7.1 billion. la from 2019 to 2021.
For example, Atrium Health has received the most money in the state, with $589 million in fallopian tube relief and $438 million in an emergency Medicare payment that boosts hospital cash flow by providing provide upfront payments for future services. The report shows that Atrium reaches a net profit of $1.7 billion in 2021 after merging with another hospital system.
Atrium did not respond to multiple emails requesting comment.
Bush said the covid relief aid had helped him afford the salaries of 13 of his employees. He said the aid does not include losses from canceled surgeries and office visits.
Bush would not provide numbers but said his operation has not been profitable since at least 2018.
Bush said at one point during the pandemic, his work shifted to telemedicine and had fewer than five patients a day.
Bush, 59, said he can’t retire because his practice is in debt. Bush may be willing to sell it but said he only received a preliminary offer for $200,000 from a hospital system that operates across the state. That offer was eventually dropped.
When asked if he would advise young doctors to open an independent practice, Bush said “absolutely not.” He said the burden of fighting insurance companies to get paid and the low reimbursement rates the government pays when treating low-income patients is too difficult for most doctors. doctor.
About a third of residents in Lee County, where Sanford is based, rely on Medicaid, a taxpayer-supported program to help low-income people pay for health care, according to the data. of the state Census Bureau and Medicaid Tracking.
“If I could go back 30 years, I wouldn’t be a doctor,” Bush said. “Looking back on life, this was a bad choice.”
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President Joe Biden has pushed the Federal Trade Commission against consolidation in the healthcare industry. In an executive order issued last year, he said, “Hospital consolidation has left many areas, especially rural communities, without inadequate or costly healthcare options. worse”.
North Carolina has one of the most consolidated health care systems in the country, according to a 2021 KHN analysis of 2018 data from the federal agency for Health Care Research and Quality. The analysis shows that nearly three-quarters of the hospitals in the state are part of a large system.
Federal and state antitrust laws are supposed to ensure a competitive market that benefits consumers. Researchers have repeatedly warned that consolidation in the healthcare industry is driving up medical costs while there is no clear evidence of improving care. A 2012 report from the Robert Wood Johnson Foundation found that when hospitals consolidate in highly consolidated markets, price increases often exceed 20%.
The Medicare Payments Advisory Committee, which does research for Congress, said in a 2020 report that most markets across the nation are dominated by a single hospital system, and this leads to higher prices.
The North Carolina Health Care Association, an advocacy group on behalf of hospitals, declined requests for interviews. In written responses to questions from KHN, spokeswoman Cynthia Charles said it was in the public interest for the hospital system to purchase independent operations. It ensures access to primary care in communities at a time when small operations are struggling to survive, Charles said. She said she could not provide data on the impact of consolidation on prices.
“We trust our members to make the right decisions for their communities,” she said. Charles added that consumers should be more concerned about large commercial health insurers using market power to create barriers to care and delay payments to providers. medical.
An American Medical Association analysis of the 2020 survey results found that for the first time since the team began tracking, in 2012, most physicians do not work for facilities due to owned doctor. The analysis cited the financial impact of the pandemic as a factor.
Barak Richman, a law professor at Duke University who studies antitrust law and healthcare policy, said the loss of independent physician practices threatens to fundamentally reshape the historical relationship. history between doctor and patient. .
Research shows that when doctors work for the hospital system, they tend to refer patients to more testing and stress treatment, which translates to higher hospital profits, Richman said. “Studies show that doctors practice in a different way,” he said. “You no longer have doctors competing to keep patients based on quality.”
“If you have the strength and courage to go on to become an independent doctor, your life will be difficult,” Bai said.
Bush said he has always dreamed of becoming an independent doctor who would answer patients’ questions and spend time getting to know them. He has worked in Sanford long enough for him to treat generations in several families.
But Bush said he knew maintaining independence would be difficult.
He began a new focus on bone care for his patients but found that the government would not cover the full cost of the test and many patients could not afford the $60 out-of-pocket costs.
“This is a poor community, the salt of the earth and nobody cares about them,” Bush said. “If we close, they may have to drive 50 miles to get care. They can’t afford gas.”
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
