Running a small independent primary care office has always come with both great rewards and great challenges. In 2005, I opened Silver Sage Center for Family Medicine in Reno, Nevada. We have been privileged to care for thousands of Nevadans over the last 18 years. As the population of northern Nevada continues to expand, we have worked hard to accept new patients, especially given the shortage of family physicians in Nevada. We strive to help every patient possible.
Running a small independent primary care office has always come with both great rewards and great challenges. In 2005, I opened Silver Sage Center for Family Medicine in Reno, Nevada. We have been privileged to care for thousands of Nevadans over the last 18 years. As the population of northern Nevada continues to expand, we have worked hard to accept new patients, especially given the shortage of family physicians in Nevada. We strive to help every patient possible.
While I get great satisfaction from caring for patients and helping people in our community improve their health, it’s been a struggle to keep my office open over the past few years. Thanks to lingering pandemic-related economic challenges, a medical workforce shortage, and the rising cost of health care across the country, it’s been increasingly difficult to keep our doors open. Like many private practices, I’ve found myself considering other options to be able to continue serving patients.
One option is to move to a direct primary care or concierge model. While I understand why many physicians are moving to this model, many of my patients would not be able to pay out-of-pocket for their care, medications, or testing. I would also serve fewer patients, which would run counter to my mission as a physician. In a state like Nevada, where we already have a drastic shortage of primary care physicians, reducing my bandwidth would exacerbate the health care provider shortage.
The other option is merging our office into a larger hospital-owned healthcare system. Many physicians like me around the country have opted for this model. In fact, an audit in 2021 showed that large hospital systems owned about 70 percent of physician practices. Small, independent practices like mine seem to be going the way of the dodo bird. It's an unfortunate trend, as many studies have demonstrated that continuity between patients and their physicians results in lower-cost and higher-quality care.
When hospital systems buy-up practices like mine, they start charging patients higher prices for care. It's the same care that patients had received at a lower cost when the practice was under private ownership. Rates charged for health care services in this way increased by an average of 14 percent.
I’ve seen the negative repercussions of this consolidation right here in the Silver State. When cardiology groups in northern Nevada went from being in independent practice to merging with hospital systems, the billed charges of routine tests such as an echocardiogram skyrocketed. Their patients couldn’t afford it – and neither can mine.
Something needs to change, and Congress knows it. They are considering several proposals regarding fair medical billing and price transparency. There are two bipartisan, common-sense solutions that would reform hospital billing practices and ensure patients are charged fair prices. These bills – the Facilitating Accountability in Reimbursements Act (FAIR) in the House and the Site-based Invoicing and Transparency Enhancement Act (SITE) in the Senate – would address unfair billing. Patients shouldn’t have to pay more for their health care based on the logo on the door.
While high costs in our healthcare system need to be fixed immediately and dramatically, low reimbursement rates must also be addressed. Independent medical practices are being squeezed and stressed out of existence. Small primary care offices are critical for patient continuity and innovation, and Congress must fight for us and our patients.