Orthopaedic practice is not getting easier. From a business point of view, it is getting harder. Reimbursement has fallen over the last several years. For many procedures, reimbursement has fallen between 30 percent and 50 percent.
This has forced many of us to become businessmen in the office. I personally have learned how to operate my orthopaedic practice as a business. I try to cut overhead everywhere. However, over the last year or so, I feel I am fighting a losing battle. As reimbursement falls, costs continue to rise. Employees want raises and benefits for these employees continue to rise.
Along with the cost of reimbursement falling, the number of uninsured has risen. It is approximately 44 million at this time and one-third of them are children. As an orthopaedic surgeon, I take trauma call in my hospital emergency room. Most orthopaedic surgeons do. We are obligated to care for patients. We are entitled to care for all comers with orthopaedic problems in the emergency room regardless of ability to pay.
When reimbursement was high, insurance companies kind of subsidized unreimbursed medical care. Unfortunately, this is no longer the case. When somebody breaks a bone, it requires a cast. We are not just giving away a service. We are giving materials away. The cost of these materials, that is, plaster, fiberglass and padding, continues to rise. It is difficult to get patients who do not have insurance to pay. I try and so do my colleagues. Unfortunately, many patients will not and cannot. There is also a legal issue. We cannot refuse care to these people if we are covering unreferred emergency room orthopedic call.
It is time that society and the government recognize what charity care really is. It is charity. Physicians who do charity care should be entitled to write off the cost of that care either off their personal or business taxes.
I am not saying we should turn away people because of their inability to pay, but what I am saying is charity care needs to be treated as charity; that is, a tax deduction. I feel we need a tax credit or a tax deduction to help make up the loss of this charity care; that is, the time and the materials given away. Unfortunately, the medical/orthopaedic practice is a business. Physicians cannot survive if they cannot recoup reimbursement. A tax credit or a tax deduction for charity care certainly would help. With some sort of tax deduction or tax credit, maybe some of the sting out of lower reimbursement will be softened.
Marc L. Kahn, MD