KevinMD December 5, 2025
Ten years ago, I quit my job and started a solo office-based practice in rural Washington. I serve patients like Mr. G, an elderly gentleman who drove over 70 miles through mountain passes and rural highways to receive care for gangrene of his foot, as nearby hospitals were either too full or too far away. But Medicare’s broken payment system is endangering practices like mine, quietly dismantling access to affordable care in underserved and rural areas.
People often hear “office-based care” and assume it means primary care checkups. But medicine has advanced dramatically. Today, complex procedures from vascular interventions to radiation oncology can safely be done in office settings without general anesthesia. The problem is the money hasn’t followed the...
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