Dr. Stuart Lustberg, 51
Cost of malpractice insurance
DR. STUART LUSTBERG sees 30 patients a day.
The obstetrician-gynecologist starts each day at 8:30 a.m., often works until 10 p.m. at his Huntington office, and is on call seven days a week if one of his patients goes into labor.
Every nine days, he moonlights at Huntington Hospital for a 24-hour shift to take care of emergencies or uninsured patients who walk through the door. This extra money helps pay his $175,000-a-year malpractice insurance, which represents 28 percent of the revenue from his medical practice.
If he's home more than once a week to have dinner with his three teenage kids, he said, it's a big deal. He took a week off for vacation last year.
He is reimbursed an average of $2,600 for nine months of care for a woman's pregnancy, including visits, tests, labor and delivery. Twenty years ago, Lustberg, 51, said, ob-gyns were reimbursed about $5,000.
"I'm embarrassed to tell people that," he said.
But, he said, he's doing better than many of his colleagues, who have to see 70 patients a day to make ends meet. He has a business background that has helped him run his single practice efficiently, he said. That means his patients wait less time to see him and he can spend five minutes with them, while his colleagues' patients may wait up to two hours and see their doctor for half that time, Lustberg said. "They are like gerbils on a wheel," he said, speaking of his colleagues.
His main complaints? First, the high cost of his malpractice insurance. Long Island ob-gyns pay more than ob-gyns anywhere else in the state. Second, so much of his time and his employees' time is spent filling out forms and haggling with insurance companies to get approval to perform procedures and then get paid for them - all of which takes away from his time with patients.
Even after medical procedures are approved, getting payment from the insurers often involves phone call after phone call. Many are made by Lustberg's wife, Regina, who works in his office.
"Why should an employee spend two to three hours on the phone trying to get paid?" Lustberg said. "It's almost a wash."
His wife said they have a joke: "OK," she said, "it's denial du jour."
with the system
Whether the insurers' behavior is calculated or incompetent, Lustberg said, "it hurts the quality of care" when doctors have to spend so much time on payment issues.
Even worse, he says, is the high cost of malpractice insurance and its impact on health care costs.
As a result, Lustberg said he and many other doctors practice defensive medicine. "If there's any possibility of missing a diagnosis, you're going to order a test."
The change he wants
Lustberg said "tort reform" - capping awards in malpractice lawsuits - would be the single biggest thing legislators could do to lower health care costs because doctors would no longer feel compelled to order every test. But he is gloomy about its prospects. In his speech last week before Congress, President Barack Obama said he would authorize demonstration projects in some states to look at ways to reduce malpractice insurance. "He threw a bone at doctors," he said. "But there's no intent."
A safety net is needed for people who can't afford health care, said Lustberg. But he also worries that mandating coverage for everyone will bankrupt small businesses like his own.
He also does not support Obama's public option, in which government-backed insurance would be offered along with private insurance. He believes that a public plan would lead to rationing of care. "I really don't trust private industry, but I really don't trust the government either to run a major industry," he said.
Instead, he favors stronger government regulation of health insurers. He envisions an expert panel that would make sure plans treated patients and health care providers fairly.
But Lustberg admits he has little hope that much good will come out of the health care overhaul. "I think the quality of care has dropped precipitously in the 20 years I have been working." As costs rise and he and others are pressured to spend less time with patients, that is not likely to change soon, he said.