All Medicare, (almost) all the time...and loving it

July 23, 2010

The 21 percent cut to Medicare physician reimbursement rates averted last month affected few physicians more than internist and geriatrician Nevada A. Lee, MD, who runs a solo practice in Raytown, Mo.

Key Points

The 21 percent cut to Medicare physician reimbursement rates averted last month affected few physicians more than internist and geriatrician Nevada A. Lee, MD, who runs a solo practice in Raytown, Missouri, just outside of Kansas City. Those rates, which may affect 30, 40, or even 50 percent of your practice's revenue, would affect virtually all of Lee's.

On June 24, Congress approved an extension of the current Medicare reimbursement rate, this time with a 2.2 percent increase, until the end of November when it's anticipated there will likely be another last-minute bill passed to avert the cuts.

Despite the lower reimbursement rates for Medicare patients and the ongoing legislative discussions looming in the background, Lee, 62, who is board-certified in internal and geriatric medicine, says that her Medicare-only practice is a professional dream come true and the culmination of a career treating geriatric patients. What's more, her practice is profitable and growing thanks to house calls, low overhead costs, and a pain management service that has helped keep the practice afloat since it opened in 2005.

"Most people said, 'Don't do it' " about her practice focus, Lee says, while chuckling. "But a lot of this is about joy, too. The freedom. Just being able to be free and not tied down from going to that room, to that room, to that room. It's just wonderful."

PERSONAL INSPIRATION AND COMMUNITY NEED

"That wasn't my cup of tea," Lee says. "I've never been one to work well in that setting. It was an adjustment to go from solo practice to corporate. By the time I got adjusted, it was over. At that point, I had no clue what I was going to do."

At the end of the church service, Lee had her epiphany when the minister asked visitors if they were ready to join the congregation. Although she was already a member, Lee descended from the balcony to the front of the parishioners to make a different kind of commitment: "I will return to practice in Raytown," she announced.

The closure of the clinic and its transportation and social services left a hole in this working-class suburb, which has the highest concentration of residents aged 62 years and older in the Kansas City metropolitan region, Lee says. Many of the elderly patients found it difficult to visit the new office or to find another practice in the area that would accept them.

Moreover, as is typically the situation around the country, the dominant private insurers in the Kansas City metro area reimburse general internists at a rate of as much as 112 percent of Medicare rates, according to IQS Research-Center for Reimbursement Studies, a Louisville, Kentucky-based research firm that studies insurer reimbursement rates for major markets nationwide.

Not long after Lee made the decision to continue providing care to the residents of Raytown, she was handed a classified ad from a new healthcare company hiring physicians to perform home visits. The company allowed physicians to join as employees, with full benefits, or as independent contractors. Unemployed and uninsured, Lee planned to join the company as an employed physician for the health insurance. The day before she signed the contract, her former employer sent her a letter that said she would qualify for health insurance due to her long tenure with the company. At that moment, she decided she was ready to take the plunge as an independent contractor.

"I just wasn't into being that tied down," Lee says with a smile. "I needed more flexibility."