Sept. 2, 2015
Bureaucratic red tape has
killed a decades-old medical practice.
After 40 years of service
and more than 20 years together, the physicians at Austin Internal Medicine
Associates (AIMA) will be closing their doors for good Sept. 4. The physicians
cited burdensome regulations ― including electronic health record (EHR)
requirements and the looming switch to a new medical billing and coding system
called ICD-10 ― as factors in their decision to close.
“It’s gotten a lot harder
to run a small personal practice, and that’s because of all the regulatory and
EHR requirements and things like ICD-10 and new HIPAA (Health Insurance Portability
and Accountability Act) regulations,” AIMA physician R. Scott Ream, MD, said.
“I mean, you could just go on and on about what we have to really worry about
all the time.”
He and his colleagues
prefer to worry about patients, not red tape. But medicine was a different
profession when the doctors at AIMA began their practice four decades ago.
Physicians Ace Alsup, MD; Isabel Hoverman, MD; Frank Robinson, MD; and Dr. Ream
told Texas Medicine magazine
being a doctor now is less about patient care and more about navigating an
avalanche of health records, government technological requirements, and
administrative red tape.
Admittedly, there’s more
to AIMA’s closure. All four physicians are retiring, and about a year after
closing the practice’s doors, three of them will be 70 years old. However, in
recent years, circumstances of the modern medical landscape made AIMA’s closure
The practice holds a
meeting each year to evaluate its current situation. Dr. Hoverman says the
physicians began thinking about closing AIMA last year, “But at our meeting
[this year], it really became obvious that the administrative burden had really
escalated even further, to the point that it had gotten just overwhelming,” she
One big factor was the
increasing prevalence of the widely maligned EHRs.
AIMA never adopted an EHR
system, citing limited resources. This year, for the first time, foregoing an
EHR hurts medical practices’ Medicare bottom line. Beginning on Jan. 1, 2015,
the Centers for Medicare & Medicaid Services docked Medicare physicians’
pay 1 percent for not meeting EHR requirements. That number increases to 2
percent in 2016 and 3 percent in 2017.
Another factor contributing
to the physicians’ decision to retire was the federally mandated switch to the
10th revision of the International Statistical Classification of Diseases and
Related Health Problems, or ICD-10, to document all patient diagnoses. Adoption
is required by Oct. 1.
The Austin physicians’
concerns over ICD-10 are not unique: Nearly half of Texas doctors over age 61
might retire early due to anticipated cash-flow problems from ICD-10, according
to a Texas
Medical Association survey released last month.
“Of all the hassle
factors, [ICD-10] is down the list a ways, but it’s definitely why we chose
[Sept. 4],” Dr. Ream said.
The decision to close was
a difficult one for Dr. Ream, and he told TMA’s Texas Medicine
getting to know his patients is one of the aspects he will miss the most.
“They’re much more like
family and friends, and that’s going to be difficult,” he said. “On the other
hand, everywhere I look tells me it’s time to retire.”
TMA is the largest state medical society in
the nation, representing more than 48,000 physician and medical student
members. It is located in Austin and has 110 component county medical societies
around the state. TMA’s key objective since 1853 is to improve the health of
Contact: Brent Annear
(512) 370-1381; cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org
(512) 370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org
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