By Lynsey Bradley

Staff writer

Physicians can't treat patients without offices and licenses, and they could lose both by practicing without insurance. Yet that is what many doctors are doing because of the rising cost of malpractice insurance.

One prominent area doctor said his malpractice insurance premiums have risen 400 percent, while the amount of coverage his insurance provides has been reduced by 75 percent. And only Congress can stop Medicare reimbursements to doctors from dropping.

With a bill before Congress that would help, and with their congressman running for re-election, medical professionals from St. Lucie, Martin and Palm Beach counties gathered at the Hutchinson Island Marriott Resort Saturday, Sept. 16 to discuss their concerns. They invited U.S. Rep. Mark Foley, R-Fort Pierce, who is seeking reelection in November, facing Democrat Tim Mahoney of Palm Beach Gardens and an independent, Emmie Ross, of Port St. Lucie.

"A lot of doctors are leaving the state to practice in Georgia, Texas and other states, and we don't want that," Rep. Foley said during the reception, hosted by Dr. Robert Fier, who operates Fier Eye Care and Surgery Centers in Port St. Lucie and Stuart.

Numerous medical staff physicians from Martin Memorial Health Systems, Lawnwood Regional Medical Center and Heart Care Institute, St. Lucie Medical Center, the Palm Beach County Ophthalmology Society and the Martin County Medical Society attended the event to express their concerns.

Dr. Christopher Rao, a Jensen Beach physician and immediate past president of the Martin County Medical Society, said his insurance payments rose from $8,000 for $1 million in insurance, to $40,000 for $250,000 in insurance.

"For the past year, I haven't been accepting new Medicare patients," Dr. Rao said. "I've never been sued, but if I were to get sued, everything I've worked for would be gone. That's why I am just choosing to keep the Medicare patients I have and not accept any new ones."

Florida law requires doctors to carry at least $100,000 in malpractice insurance, and they must have at least $250,000 in coverage to practice medicine in hospitals.

Beth Williams, director of public relations at Lawnwood Medical Center, said rising insurance costs end up hurting patients.

"We all need to focus on the patient," Ms. Williams said.

"When physicians aren't practicing in a hospital, it results in a shortage," she said. "If a doctor did obstetrics and gynecology, he may drop obstetrics because of the liability costs. So, you have fewer physicians delivering babies.

"We agree with the physicians that something must be done about this," Ms. Williams added.

A loophole in the law allows doctors to practice without insurance, but those who do tend to have personal accounts available to settle out of court, if a malpractice suit arises. They must also post signs saying they do not have insurance.

Dr. Rao said he has never been sued, but he pays just as much for insurance as doctors who have been sued, which is why he refuses to take new Medicare cases.

He also said he believes the healthcare system is reactive rather than proactive.

"The best thing would be for government to pay for preventative care for all people, regardless of age. That way, doctors wouldn't have to be so careful when accepting new patients," he said.

The reception was designed to benefit the re-election campaign of Rep. Foley, but in return the doctors want action on insurance and Medicare reimbursements.

The congressman agreed that something must be done.

"We want to keep our doctors here in Florida," Rep. Foley said. "Doctors are critical, so we're looking to get them more malpractice relief and better Medicare reimbursement."

The Congressman said Florida is being hit so hard in Medicare reimbursements because so many are choosing to retire in Florida. He promised to work for more Medicare relief and better reimbursements.

Without help from Washington, more doctors will continue to practice without insurance or will opt to leave the state in search of better medical markets.

Florida doctors see Rep. Foley as a key supporter on the issue. According to his Web site, the Congressman is working to "modernize" the Medicare program by making it a wellness program, rather than an insurance program.

On Feb. 1, the U.S. House passed the Fee Fix Bill, as part of a budget bill that passed by just two votes. The vote eliminated a 4.4 percent reduction in Medicare reimbursements this year, but physicians are scheduled to see a 4.5 percent reduction in 2007, unless Congress acts again.

Meanwhile, the average reimbursement per visit ranges from $35 to $70, which Dr. Rao said is equivalent to what doctors were receiving in 1965.

"It costs money to live here," said Dr. Rao. "But, it's not about the pay. It's about healthcare for people of all ages."

The doctor also suggested an incentive be given to those who take steps to remain healthy, such as free passes to health clubs for the obese and tax breaks of $500 for patients who have good yearly examination results.

He said more people are unable to get healthcare, and paying doctors less won't help.

"I became a doctor to save lives and make people healthy, but I can't do that if I can't afford to keep my office open," Dr. Rao said.

Doctors at the reception said they are committed to the health of Florida residents, but accepting a "high-risk" patient who could cause them financial ruin is not an option when they can't afford malpractice insurance.

"There's that song: 'Mamas, don't let your babies grow up to be cowboys,'" Dr. Roa said. "Well, I say, 'Mamas, don't let your babies grow up to be doctors.'"