When Barack Obama was elected President of the United States in November, promising to reform the country’s health care system, Sag Harbor’s Dr. John Oppenheimer hoped his practice would stay afloat financially while still offering the kind of comprehensive care he expected to provide for his patients since graduating from Tulane University in 1981.
However, as Congress continues to remain virtually deadlocked on a solution to the country’s health care woes, and with costs rising on his 13-year-old Bay Street office, Dr. Oppenheimer last week sent word to his some 2,000 patients that he would have to restructure his medical practice, instituting changes that he sadly admitted will result in some of his longtime patients seeking care elsewhere.
As of September 14, Dr. Oppenheimer, who will remain a primary care physician with an emphasis on care for the elderly and HIV medicine, will only accept Medicare, federally administered health insurance for seniors. Those with private insurance plans offering out-of-network coverage will be required to pay Dr. Oppenheimer’s Medicare-based rates up front while seeking reimbursement on their own. Patients with Medicare will have their paperwork processed by Dr. Oppenheimer’s office.
He will also require patients to pay an annual retainer of $1,600 per person, although he said on Wednesday that if the retainer posed a financial hardship to current patients, he would be willing to discuss the cost.
“My practice was reaching a point where I needed to see more and more patients to keep up with expenses,” Dr. Oppenheimer said on Wednesday. “I also was beginning to have the feeling that I did not have the time I needed to provide the services I want to give people.”
In addition to his basic office expenses, Dr. Oppenheimer said malpractice insurance has been his largest expense. And with an unlikely increase in private insurance reimbursements, he said the best way to maintain his practice was to see about 40 patients a day.
“That is not the doctor I wanted to become,” he said.
“On a personal note, this was a terribly hard decision for me to make,” said Dr. Oppenheimer. “The most difficult part of this decision was knowing what a difficult position I am putting a lot of my patients in. I didn’t really want to do this, in a way, but I considered all my other options and I felt this was the way to go.”
In addition to a mass mailing, Dr. Openheimer held three public sessions to talk one-on-one with patients interested and concerned about the transition. He has also urged patients to come to the office privately to discuss any questions or concerns.
Dr. Oppenheimer said the reaction from patients so far has been mixed.
“I think most people appear to understand, on one level, why I am doing this,” he said. “On the other hand, I think some people are upset because I have been their doctor for many years and some of them will have to find other providers.”
On Tuesday, Diane Schiavoni, who has been with Dr. Oppenheimer’s practice since its inception, said she has already switched doctors in light of the restructuring. Her husband has not made up his mind on whether to stay with the practice.
“I hope it works out for him and I wish him lots of luck, but I just don’t think it is for me,” she said.
Sag Harbor resident Diane Gaites was undecided on what she would do, mulling over her options after being surprised by Dr. Oppenheimer’s letter.
“Basically, I can understand why he is doing it, in light of what is going on with insurance companies and the low payments these doctors get back,” Gaites said.
Carl Peterson, who was a patient of Dr. Oppenheimer until last year when he switched providers due to a change in insurance, also received the mailing.
“I think above all else it is a sign of how tough it is right now with our health care system,” Peterson said. “It has really gotten to the point where health care is a members-only thing.”
Dr. Oppenheimer agreed the health care system is in need of reform.
“I think the current healthcare system is not necessarily good for patients and not good for providers,” he said. “I think radical changes need to be made. The health insurance industry pretty much controls the agenda.”
Dr. Oppenheimer said a Medicare-type insurance plan, offered to everyone and not just the elderly, would be a change that would benefit both patients and providers.
“Unfortunately, the reality is that is not going to happen right now,” he said. “Every other industrialized country has some kind of single payer, government health plan. They spend significantly less on health care and their outcomes on major medical indicators are often better.”
Despite lamenting the change in his medical practice, Dr. Oppenheimer believes he will now be able to provide a higher level of service to his patients.
After becoming re-certified in geriatrics, and finding that aspect of his practice becoming more and more of a focus, Dr. Oppenheimer said he needs to spend more time with patients in order to provide comprehensive care.
For those patients, he will begin performing a “comprehensive geriatric assessment,” often done at academic medical centers that provide a more complete medical evaluation for each patient. “I will also be working with nutritionists, social workers and a physical therapist to provide coordinated and comprehensive care,” he said.
As a part of Dr. Oppenheimer’s new practice, patients can expect to see him virtually on an on-call basis.
“I expect people will not be waiting for their appointments,” he said. “I will also be spending more time with people during their appointments, so both patients and myself don’t feel so rushed.”
Dr. Oppenheimer said house calls would also be possible.
“One reason I am doing this is I plan on staying in Sag Harbor for many, many years,” he continued. “Right now, I have been drawing off my life savings for quite awhile and I have three kids about to go to college. I need to develop a model that can balance my work and provide for my family.”