LISLE BERWYN ‚ One family physician is taking a different approach to ensure he can stay in practice, while continuing to care for the uninsured patients who depend on him. This is the story of Mark Macumber, M.D. and his new approach, the "Patients First" model to provide quality care without the burdens and out of control costs of professional liability insurance.

Mark Macumber, M.D., 35, has been employed by West Suburban Hospital in Oak Park since graduating residency in 1997. " Despite working everywhere from emergency rooms to intensive care units, and delivering babies from high-risk mothers with no prenatal care, he has never been directly sued. He was named in one case during residency, under the "include every name on the chart" philosophy. The case was dismissed without prejudice.

In April 2000, with the permission of West Suburban, he started a part-time private practice treating patients with vein disease. At that time, he obtained coverage as a part-time primary care practitioner with minor surgical component, and no inpatient work. "I was informed that my initial premium would be about $2,500, and would increase over the next seven years to cap out at about $11,000," recalls Macumber

In October of 2001, Dr. Macumber became the Medical Director for the Township of Berwynís Public Health Department. In that role, he launched and supervised six clinics a month, to deliver free primary care services to the uninsured residents of Berwyn.

Part of my agreement was that I would provide my own malpractice insurance, which was manageable at that time," he says. "My policy had a starting premium of approximately $4,500. The second year, it jumped to $10,000. This March, I received the news that in the fourth year it would be just over $20,000. But when my premium renewal notice arrived in the mail in May, my premium was now actually $40,000.

"I have $130,000 in medical school loans to pay, and I just purchased my home last year. It was now going to cost me personally to keep my clinics open," explains Macumber. "I asked the health department to contribute, but they couldnít. We tried for grant money, but ultimately I had to give up. We shut down those clinics, and I abandoned those patients."

Before the clinics were closed, Bonnie Johnson of Berwyn came to the Berwyn Health Department for a Pap smear. As an uninsured mother of three, she had not seen a doctor in nearly ten years. She borrowed money for the health department visit, where Dr. Macumber discovered she had cervical cancer. "He worked hard to get me the medical attention that I needed," says Johnson. "If it werenít for that Pap smear and his work to get help for me, I believe I would have died."

Another surprise arrived with that policy renewal. Over the last two years, Dr. Macumber had been aggressively and safely treating obesity ‚ the fastest growing health problem among his patients. Using a case management approach with a nutritionist and a behaviorist, he has been able to take some of my chronically ill patients off of some medicines as they showed improvements in obesity-related diseases, such as diabetes and hypertension. Although the U.S. Surgeon General has determined that obesity is an epidemic in this country, and that it rivals tobacco in causing preventable deaths and disease, his malpractice carrier excluded that service from their coverage.

Patients First is Dr. Macumberís answer. "I am starting with the premise that my first goal, my only goal, is to do my best to take care of my patients. If they canít afford to see me, it means I have to find a way to make it affordable. That means I have to cut my costs, and eliminating $40,000 in malpractice insurance premiums greatly reduces my cost of operating a practice. To do this puts me at tremendous personal risk. But I canít continue to pay whatever price is demanded is to support a system drains the resources of good physicians and reduces access to affordable health care."

Next he cut out the costs related to accepting medical insurance. Accepting insurance means having full time staff dedicated entirely to billing insurance providers. "It means spending time justifying and arguing my medical judgment with carriers when I could be seeing patients instead," claims Macumber. Accepting insurance also means extra computers, software, paper, copies, phone calls.

Uninsured patients are forced to emergency rooms for routine conditions because they can be seen by a doctor, and worry about the cost later. In many cases, uninsured patients donít seek care at all. Their conditions only worsen, or a disease goes undetected until it is too late for treatment. Currently over 592,000 people are uninsured in the city of Chicago and another 622,367 are uninsured in the metropolitan area outside of Chicago.

The Patients First approach centers on providing access to care. It is an attempt to make health care affordable to those patients who are left out of the existing health care system by offering them primary care services on a low-cost cash basis.

"I do not propose that the details of this approach are the solution to the health care woes of all in this nation," says Macumber. "However, until an adequate political solution is enacted, I will not walk away from those I pledged to help. I will stand by placing my Patients First, and trust in them as I ask them to trust me."

For complete information go to Dr. Macumberís Web site at www.savemydoc.com

The Illinois Academy of Family Physicians (IAFP) conducted their active membership survey in May which revealed that the exponential rise in medical malpractice premiums is the number one concern reported by 37% of respondents. Declining reimbursements finished a distant second at 24 percent. Read other personal accounts from Illinois family physicians across the state click here.

At the same time, Texas-based staffing firm Martin/Fetcher released its Annual Physician Compensation and Benefits Report, which revealed that the average income for a family physician in 2002 was $155,000, unchanged from the 2001 average. Family Physicians who practice obstetrics saw a modest 1% increase from $160,000 to $162,000. Yet malpractice insurance rates for both categories of family physician are rising at high double-digit rates. In some cases, rates have actually doubled for physicians.

"Many family physicians have already taken difficult steps; some no longer deliver babies, others have stopped taking new Medicare or Medicaid patients," says Ellen Brull, M.D., IAFP president-elect and a family physician in Niles. "Some physicians seriously wonder how long they can keep their practices afloat."

Illinois family physicians care for 70 percent of the stateís population. If they can no longer provide primary care services, where will patients go for their healthcare? Family physicians are the only doctors who are distributed throughout the state, and are trained to treat 85-95 percent of the healthcare problems presented by patients.

"Physicians canít afford to wait for Washington or Springfield to come up with a solution that will take years to affect our premiums. The entire system needs an overhaul that will provide relief now," says Brull. Components of effective reform would include a statute of limitations for filing a claim, notification of other payments made to the plaintiff and limits on attorneyís fees as part of the judgment.

"We also need to put malpractice cases in the hands of qualified medical professionals who can accurately judge if a provider did or did not meet standards of care. The issues and the stakes are too complicated for the average jury to effectively and fairly evaluate," concludes Brull.

As for his bold step in a new direction, Macumber is determined and optimistic about the future of his untested system. "I am confident that I can make this idea work," says Macumber. "I have been bolstered by the support I have received from my patients who are understandably as upset as I am. I plan to notify every Congressperson, every politician, and interested patient advocate organizations of my new approach.

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EDITORíS NOTE: To arrange for a tour of the facility and photos, please contact Ginnie Flynn by 9/22/03. If you would like to interview Dr. Macumber, or a member of the IAFP leadership, please contact Ginnie Flynn at 630-435-0356 x118 or 630-263-4613 (cellular). To view the complete IAFP "Who Will Care?" report about the role and distribution of family physician, click here or request hard copy with an e-mail to gflynn@iafp.com.

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