Feeling the pinch

Strapped: A physician solicited donations from his patients to meet a big increase in malpractice insurance.

December 12, 2003|By M. William Salganik | M. William Salganik,SUN STAFF

Confronted with rising malpractice premiums, Dr. Kenneth Greene, an internal medicine doctor in Towson, devised a creative solution: He wrote his patients asking them to chip in $10 apiece voluntarily.

If a doctor asking his patients to contribute to the well-being of his practice seems unusual, consider that during the past week they've sent him $3,000 in increments of $10, $20 and $50 - enough to offset the increase in his malpractice bill.

Greene called the response so far "very gratifying."

Consumers and employers may be disturbed by the rising cost of medicine. But on the flip side are doctors who feel hemmed in by rising costs - from staffing to malpractice insurance premiums - and reimbursement rates pre-negotiated with insurers or set by government programs such as Medicare.

The median compensation for internal medical doctors rose about 10 percent between 1998 and 2002. That was less than the 16 percent increase in median pay for all workers and nearly 17 percent increase for professionals such as engineers, architects and business executives, according to the Bureau of Labor Statistics.

To offset rising costs, some physicians have begun charging small fees - in the $5 to $15 range - for not-exactly-medical chores, such as filling out camp physical forms. Others are setting up "boutique" or "VIP" services, charging an annual fee of $1,500 or more to patients willing to pay for the convenience of 24-hour availability or guaranteed next-day appointments.

Still others have begun selling skin lotions or doing cosmetic procedures such as botox and dermabrasion treatments - cash sidelines not covered by insurance, so doctors are free to price them without worrying about insurance contracts.

But Greene's appeal for patient contributions is an approach many local and national medical experts said they hadn't heard of before.

"The dilemma physicians face is that operating expenses are going up 6 to 6 1/2 percent a year, and their income isn't going up to match," said Dr. William F. Jessee, president and chief executive officer of the Medical Group Management Association, a national professional organization for managers of physician practices based in Colorado. "When those two lines cross, something's got to melt."

Elizabeth Woodcock, a consultant to physician practices and a writer for the Baltimore-published magazine Physician Practice, said she visited one medical office recently that billed patients $5 for the right to see the practice's federally required medical privacy statement.

"I hope you're laughing," she wrote in an electronic newsletter for Physician Practice. "Most patients don't want the paper that you hand them; they sure aren't going to pay for them."

Greene, 46, said the idea of soliciting contributions came to him gradually after several years of costs rising - for rent and staff salaries as well as insurance. Meanwhile, insurance companies, seeking to hold down medical costs, kept reimbursement rates flat or lowered them in some cases.

"I jokingly said to my staff, perhaps I'd put a box out and ask for donations like a street musician," he recounted.

When he received his malpractice insurance bill a few weeks ago - $11,000 for the year, up from $8,000 - he decided to put a variation of that plan into effect.

The malpractice insurer for most doctors in the state, Medical Mutual Liability Insurance Society of Maryland, won approval for a 28-percent rate increase this fall, and mailed out bills last month. The increase was mainly due to a rise in insurance claims and, to a lesser extent, a lower return on investments.

Greene's increase was fairly typical for a primary care doctor, said T. Michael Preston, executive director of the state medical society. Greene said he has never been charged with malpractice.

The rate of increase can be much greater depending on the specialty. The Maryland chapter of the American College of Emergency Physicians reported last week that its members had received average premium increases of 60 percent.

"I don't think I was angry at the time I wrote the letter, maybe a little sad that I would have to ask people to help me," Greene said, sitting in a Spartan office cluttered with patient files. He speaks not as a rebel or agitator about his donation appeal, but thoughtfully and gently.

Greene didn't grow up wanting to be a doctor. His junior year at Harvard University, the Massachusetts native realized that "college was ending" and he had to make a career choice. He attended the Medical College of Virginia, then did his residency in Chicago.

At first, he considered academic medicine, and worked for a few years at the University of Maryland and the Veterans Administration. He later decided to concentrate on patient care, rather than teaching and research.

When he began his own practice about a decade ago, he said he got a favorable deal from an insurer, Prudential, which was looking for a doctor for one of its health maintenance organization offices.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.