Are bankruptcies by physician practices really spiking? How would we know?

April 9, 2013

There's only problem with CNN"s recent attention-grabbing article on physician practice bankruptcies: We have no idea if its basic premise is even true.

It's a scary headline, one that screams for physicians' attention: "Doctors driven to bankruptcy."

A CNN.com article published earlier this week told the tale of unfortunate and hardworking physicians, who, through no fault of their own, were being forced to shut down their businesses by familiar health industry bogeymen such as malpractice costs, declining reimbursements, and excessive compliance costs.

"It's a trend that's accelerated in recent years, industry experts say, with potentially serious consequences for doctors and patients," the article states.

Facilitated by its accompanying #bankruptdoctors hashtag, the article sparked indignation on Twitter.

"Great article by @CNNMoney!" said the American Academy of Family Physicians. "We need fundamental changes in how physicians are paid."

"There's no independent option left for primary care," said Dr. Hans Peterson.

The physician-practice bankruptcy "problem" makes for a sexy headline and sparks an emotional response. After all, with a supposed looming doctor shortage, doesn't the United States need all the physicians it can muster?

There's only one problem with the article: We have no idea whether its basic premise is even true. It's built on one key piece of data from Bobby Guy, co-chairman of the American Bankruptcy Institute's (ABI) health committee, who told CNN that he noticed eight physician-practice bankruptcy filings in March, which he said is a "very unusual" number.

So how many physician practices filed for bankruptcy in February? What about last March, or March 2011? If physician bankruptcies have "accelerated in recent years," then don't we need some historical comparison data to verify that statement?

You'd think so, but that's not likely to happen.

Nobody can say for sure because no official source of physician-practice bankruptcy filings exists, Guy said in a phone interview with Medical Economics.

"The evidence is anecdotal, not statistical," said Guy, who tracks Chapter 11 filings as part of his job. "We tend to watch the trends, and to us that seems high."

Statistics published on the ABI's Web site essentially just break down bankruptcies into broad categories, reporting the numbers by filing location or chapter number, for example. It's impossible, it seems, to obtain a breakdown by industry.

Guy and his colleagues obtained the March number by combing through individual bankruptcy filings. It's possible more than eight occurred. Just like the rest of us, Guy can't say for sure.

To be clear, Guy's just doing his job and calling things like he sees them, but for CNN it's another story. Should Guy's admittedly anecdotal evidence be enough of a foundation for CNN to base a report on?

Now it certainly seems logical that physicians practices could be filing for bankruptcies more often than they were previously. Reimbursements are down. Some patients are foregoing necessary care. Government-mandated electronic health record systems are expensive. Physician burnout is up, and job satisfaction is down. In short, times are tough.

"My experience is that there are heavy economic pressures on the medical community, and that is driving a trend of financial distress," Guy said, and it's tough to argue with him.

But without any solid historical data to back it up, the "physician-practice-bankruptcy-is-accelerating" idea is only a theory that may or may not have any basis in reality.

Still, it's a theory that generated a sensationalistic headline and a little Twitter vitriol, and for CNN, that's probably good enough.

 

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