More Texas doctors dipping into personal reserves to keep practices alive
■ Many express concern about rising costs, declining reimbursements and health system reform.
A higher percentage of physicians used money from their personal reserves or secured bank loans to keep their practices afloat in 2010, according to preliminary results of a survey released Feb. 28 by the Texas Medical Assn.
"There's a significant worsening of the practice environment," said TMA President Susan Rudd Bailey, MD. "It's extremely difficult for small private practices to survive."
A final report will be released later in 2011. But early data from a biennial survey of 3,580 member and nonmember physicians in Texas found that 61% said their income decreased in the last two years. This number was the same in 2008, but 55% reported income declines in 2006.
In addition, 69% had cash flow problems because payments from government and private insurers arrived late, below what was billed, or not at all. This improved slightly from the 73% that experienced such cash flow problems in 2008, but the continuing financial pressure is taking more of a toll.
About 51% of physicians whose practices had cash flow problems drew from their own accounts to keep them going in 2010. About 33% said the same in 2008. In addition, 33% took out commercial bank loans in 2010 to stay in business, and 22% did so in 2008.
In 2010, 33% of practices with cash flow problems laid off employees and 23% terminated or renegotiated plan contracts. Twenty percent reduced or terminated services to government payers, and 5% closed or sold their practices. Questions about these actions were not asked in prior surveys.
Previous national surveys by other organizations have suggested that a significant number of physicians are contemplating leaving private practice in response to financial pressures or fears about health system reform. The Texas survey found that concern was high about the Patient Protection and Affordable Care Act approved in 2010. About 59% had a very unfavorable opinion of the act, and 18% said it was the biggest challenge their practice was facing.
"There's still a great deal of uncertainty among physicians about what it is really going to mean to their individual practices," Dr. Bailey said. "There are so many unanswered questions."
An additional 11% cited third-party interference as the leading challenge to their practice, and 33% said low reimbursements that continue to decline are a critical challenge.
This is considered particularly key because Texas, like many states, is discussing significant cuts to its Medicaid program. The Texas Medical Assn. said it is using the survey results in its efforts to advocate against cuts.
The survey found that the number of physicians who accept all Medicaid patients held steady at 42%. The count of physicians taking all Medicare patients held at 66%. Concern is high that the numbers, which are viewed as low, will decline further if cuts to either program go through.
Experts said some physicians may continue to participate but further restrict the number of Medicare and Medicaid patients they treat.