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Real Estate Bisnow
August 5, 2008

Internist's View:
Medicare or Bust


In our haste to cover last month's Congressional Medicare saga, we left out part of the story. Some astute reader e-mails tipped us off to the fact that only chatting with specialists did not present a complete picture. For many internists, such as geriatrician Susan J. Miller, opting out of Medicare is not a viable option. We stopped by her hole-in-the-wall Bethesda office and heard how she would have coped with the 10.6% cuts. "If the cuts had gone through, I would have had to close my practice," she told us, succinctly.


Susan is medical director at HCR Manorcare and Manorcare Chevy Chase, so about 90% of her patients rely on Medicare. Therefore, any cuts immediately impact the survival of her practice. Another way she differs from specialists is she can't make up for lost revenue simply by doing more procedures. Her "procedure" is listening, diagnosing, and coordinating care amongst health professionals (dieticians, social workers, physician extenders, etc.) She can't boost earnings simply by spending more time with a patient. To compare, her husband, a local anesthesiologist, does get to bill in units of time. While Susan speculates her selection for the Washingtonian Top Docs was likely based on her bedside manner and not business acumen, she says that even she sees this is a flawed business model.


Susan's longtime friend Loreto Albiol, also a geriatrician, shares the office space and was able to pop in for a photo. Just five years ago, both nursing homes that Susan visits had at least 10 physicians. Now, as doctors leave for financial reasons, that's been halved. Susan did suggest she could free up time to see more patients by switching to electronic medical records. But, constrained by Medicare, she could only afford the switch to EMR's if she sees more patients. (In medical terms, we call that a Catch-22, Part-D.) No wonder Susan's not too upset her daughter, a biology major, has no plans to attend med school.


Curtis Raye understands the struggles of geriatricians. It took him six years to convince his grandmother to stop calling e-mail "Sending an AOL." (Was that offensive?) Send feedback and story ideas to Curtis@Bisnow.com.

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