July 17, 2024
Can't Get Into Your Doctor's Office? You're Not Alone
By Nariman Heshmati, MD, and Jennifer Hanscom
As The Seattle Times and other media outlets have reported, hospitals in our state - places Washingtonians depend upon for surgeries, births, inpatient, and emergency care - face ongoing financial instability from the pandemic, difficult-to-discharge patients, low reimbursements, and inflation.
But there's another story that doesn't get much attention in the press: The loss of the outpatient services every Washingtonian relies on for routine and preventive care.
The lack of access to care in the outpatient community, aka the physician's office, should be as concerning to every Washingtonian as our struggling hospitals. It is in these outpatient settings that your diabetes or other chronic condition is managed, where you receive wellness and prevention screening and care, and where your personal physician manages your health. Research shows that a consistent relationship with a doctor or other primary care clinician is associated with improved overall health and fewer emergency room visits.
Outpatient medical groups suffer from many of the same challenges hospitals do: thin margins, increased costs, low reimbursements (including underpayments from Medicare and Medicaid), and staffing issues. In the past few years, payment for physician services has dropped nearly 10% in Medicare, causing a ripple effect of reimbursement decline as Medicare is used as a benchmark for both Medicaid and commercial payments.
Patients and communities across Washington feel the effects of declining reimbursements and rising costs. As reported last November, Seattle OBGYN closed after 73 years, impacting more than 16,000 patients, more than 300 of whom are pregnant. Multispecialty clinic Palouse Medical in Pullman has decided to merge with a local hospital to keep its clinic open. Ear Nose & Throat Associates SW in Olympia, having already dropped one Medicaid plan in 2023, reports that it will limit the remaining Medicaid patients over age 18 to just one per day to stay financially viable. Carol Milgard Breast Center in Tacoma reports booking crucial cancer screenings and exams six or more months out. Kitsap OBGYN reports routinely being double-booked and pregnant patients having to wait to see their physician until the second trimester.
Even nationally, Walmart, with 51 health centers across five states, noted they can't make the numbers work and are closing down all of their health centers, citing "the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time."
Care should be about the patients, not profitability. But when revenue is less than expenses, you can't pay your staff's salaries, you can't pay the lease on your office space, and you can't keep your lights on. It is not uncommon to talk to a group of physicians who own their practices who have cut their salaries or stopped taking a paycheck to care for their patients and pay their staff.
To have a healthy health care system, where patients can access care at the right place, right time, and in the right setting, we must not ignore the impact of these outpatient clinics. To help our struggling medical groups and patients, in 2024, the WSMA worked with legislators to introduce legislation to implement a "covered lives assessment" in our state, a funding mechanism that helps the state access federal funds to increase investments in Medicaid.
We will be pursuing this in next year's legislative session and will work with lawmakers to strengthen the proposal. The additional $400 million from the covered lives assessment and the federal matching funds will be a lifeline for these medical groups, will help physicians see more Medicaid patients- both primary care physicians and specialty care such as dermatology, immunology, neonatology, anesthesiology, and more-and help preserve the balance of care delivery in our state so routine community care and hospital care both are valued and available for Washingtonians.
Nariman Heshmati, MD, is an OB-GYN in Everett and president of the WSMA. Jennifer Hanscom is CEO of the WSMA.
*Note: A version of this article ran in The Seattle Times on May 20, 2024.
This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.