Independent Doctors Explain Their Plight in the World of the Affordable Care Act

Editor's note: The Patient Protection and Affordable Care Act does not currently ban doctors from conducting tests on premises, however, there is legislation proposed by President Obama that is now before the U.S. House which does specifically ban onsite testing in physician offices, Dr. Andrew Gordon said. "This legislation, if passed, would reduce access to care for millions of patients, especially those with limited mobility; it would doom independent physician practices that are already struggling, and it would exacerbate the trend created by the PPACA toward monopolies of care, reduced choice and higher cost," Gordon said.

Dr. Andrew Gordon walked across the airy, tastefully decorated waiting room as he guided U.S. Rep. Peter Roskam into an office where a technician was doing an MRI.

Gordon explained his office, Northwest Neurology, provides onsite testing. It’s a convenience for patients who sometimes can’t get around easily, he said.

Under proposed legislation tied to the Patient Protection and Affordable Care Act known as PPACA, doctors would not be allow to provide testing onsite, Gordon said. 

There are pieces of the ACA that Gordon fears will drive independent practices out of business, creating a monopoly among health care systems, costing patients more while limiting their choices.

Gordon and his partners recently invited Roskam to visit the practice to learn firsthand what independent doctors are facing today. There are eight doctors in the practice along with Gordon.

“We need some help,” Gordon said. “If government policies continue, it will force us all out of business. It won’t be good for patients.”

Challenges for independent doctors

What Gordon has seen is a drop in reimbursements and an increase in regulations. The changes have hit specialized fields, like neurology, hard, Gordon said.

Doctors in his practice observe patients following an illness, conducting tests in person to make sure everything is fine. The reimbursement for the observation was cut by 50 percent, he said.

Regulations, like HIPPA and computerized medical records, have caused a burden on independent practices because of the increase work and staff required to meet the regulations.

There’s been a tremendous drop in reimbursements for specialty testing, like MRIs. Northwest Neurology has the ability to do neurological testing in house, but the ACA would prohibit doctors from doing tests in the office, he said. Patients would have to travel to other locations, sometimes far away, for tests, he said.

Gordon is not lamenting the loss of revenues; it’s not about his practice making money, it about doing what’s right for patients.

Health care reform has caused practices to be sold to hospital systems where patients are losing their ability to have a choice, he said. He said it is becoming a monopoly.

“These are trends we are seeing,” Gordon said.

Independent practices are weathering the storm, he said. He and his partners have a niche and a good practice, but “we won’t be able to weather the storm if things don’t change,” he said. “It wouldn’t be good for our patients if we don’t survive.”

A lack of understanding

Gordon feels legislators do not understand the plight of independent doctors so he and his partners invited Roskam to visit their Lake Barrington office.

Roskam agreed there’s a push toward making independent doctors part of a big health care system, which is a concern for him too.

“It’s not right. Monopoly health care goes against the grain of American health care,” Gordon said.  “I think it’s going in the wrong direction. Independent practices need to be able to advocate for themselves and fight back for our patients.”

There are other affects the ACA may have in Gordon’s field. There is already a shortage of neurologists while the need for their services is increasing, he said.

Every year, 795,000 people have a stroke, he said, citing national statistics. Over 5 million people have Alzheimer’s. Two million have epilepsy and 500,000 people have Parkinson’s disease.  

By 2030, the percent increase of people who will have neurological diseases is startling, he said. Parkinson’s disease is expected to increase by 60 percent and Dementia by 70 percent.

“The shortage of neurologists is likely to increase as the government makes it more onerous to survive,” Gordon said.