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Running a Medical Practice: Does Government Help or Hurt?


The goals for most federal government mandates are well intentioned, but the execution of them, and impact on physician offices, are counterproductive.

Over 30 years ago, I began a cardiology group practice - Bay Area Heart Center - in St. Petersburg, Fla. I invested $30,000 - all of my savings at the time, and worked between 90 hours to 110 hours per week for three years before I hired a partner. Since then, the practice has grown to about 50 employees, including 12 physicians.

I was taken aback by President Obama’s recent remark, “If you’ve got a business - you didn’t build that. Somebody else made that happen.”

Did I have help building this business? Yes. I have been graced with fine physician-partners, nurses, physician assistants, secretaries, medical assistants, and a remarkably efficient and dedicated administrative staff. But in all due respect, Mr. President, I must disagree with you. I did build my business, and nobody else made it happen. Moreover, along every step of the way, the federal government has been more of an impediment to the growth of my business than a facilitator.

From Medicare dictating to me how much I can charge a patient for my services, to OSHA requirements against using lip balm in "patient-care" areas, federal rules, regulations, and bureaucracies have heaped increasing administrative costs on my business without one iota of improvement in patient care. Now with the imminent implementation of "Obamacare" dangling over us, the outlook is even direr.

Most small business owners I know work incredibly hard and sacrifice personal health, well-being, and relationships to grow their company. We aren’t looking for a handout or a free ride. We would, however, appreciate the government unshackling us from a tsunami of regulations which only choke and impede our ability to compete in the free market.

The burdensome rules in the healthcare field could, and probably do, fill the federal registry. Profits in private medical practices are becoming so squeezed that a recent survey of 673 physicians across 29 specialties by MDLinx, a medical reference website for physicians, indicated that 17 percent of all doctors with a private practice said they could foresee closing it within a year if their financial situation doesn't improve. The major reasons sited were significant school debt, rising business expenses and administrative hassles, shrinking insurance reimbursements, and costly malpractice insurance.

My office nurse spends the better part of one whole day instructing a new employee on HIPAA, OSHA, and other alphabet soup agency rules and policies so we can stay within compliance guidelines. And this time doesn’t even account for electronic health record training or how to do the job for which he or she was hired. So for those one to two days, our nurse cannot assist doctors or contribute to actual patient care. And if the new employee decides to quit within the 90-day probation period, the nurse must do this all over again. In fact probably the fastest growing position in small businesses these days is the compliance officer.

Did you know that a cardiologist’s office is a hazardous place to work? According to OSHA, dangerous substances such as alcohol wipes and disinfectants (which anyone can purchase in a drug store) must be described to employees. To comply with OSHA, you must have a written list of the hazardous chemicals stored or used in your office. For each of these, your employees must also have access to the manufacturer-supplied Material Safety Data Sheet. The MSDS outlines the proper procedures for working with a specific substance and for handling and containing it in a spill or other emergency.

HIPAA was meant to protect patient’s privacy. Who could possibly be opposed to that? Unfortunately, the regulations are too open to interpretation. This means every facility has a different policy. Thus, when you sign in at the front desk to be seen, you might not see other patients’ names. However, when it is your turn to see the doctor, you can hear someone yell, "Mrs. Smith, please come back now."

The goals for most federal government mandates are well intentioned, but the execution of them, and impact on physician offices, are counterproductive. Through Medicare, or CMS, financial incentives, we are encouraged to report Quality Measures, submit paperless drug orders, and use an EHR. However, the programs don’t work in tandem with all healthcare providers resulting in costly duplication of time and effort.

Many other mandates are completely unfunded, resulting in the doctor and his staff doing more work in order to get paid less. For example, CMS requires us to pay for a translator for any patient who doesn’t speak English at the cost of $150 per hour, which is more than the reimbursement for a typical office visit. Medicare recently took away all codes related to performing consultations, resulting automatically in cuts to specialists.

Innovations in healthcare don’t come from some federal agency "think tank," which is kind of an oxymoron. If you look around from city to city, the best centers of excellence, be it an eye, orthopedic, or heart institute, are named for private citizens who are philanthropists ¬- not some senator or congressman.

It doesn’t take government to help small businesses to grow, Mr. President. The best it can do is get out of the way and let the free market and the American spirit of entrepreneurship flourish.

Find out more about David Mokotoff and our other Practice Notes bloggers.

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