Commonwealth Journal

December 11, 2013

Dr. Who? Somerset M.D. Stephen Kiteck’s views on Obamacare make FOX newscast as he closes practice

His 4,000 patients will need to go elsewhere

by Chris Harris
Commonwealth Journal

Somerset —

Dr. Stephen Kiteck seems an odd fit for the world of cable television news.
It’s an arena of talking heads which often seem in a competition to see who can shout the loudest, yet Kiteck seems soft-spoken, even-tempered. Professorial, even.
Yet there he was on Tuesday, speaking to Fox News host Greta Van Susteren on the TV — perhaps the most unlikely candidate to be thrust into the middle of a hot-button national debate over health care reform.
“We were kind of shocked, ourselves,” said Kiteck on Wednesday. “The last 24 hours, we’ve gotten an unbelievable number of calls.”
Kiteck is a longtime general practitioner in Somerset, part of the local medical community for the last 35 years. He’s developed a sizable and devoted client base — about 4,000 active patients — and is known for an honest, straight-forward approach to medicine that might have seemed just as appropriate 50 years ago as it does today.
Part of that is seen in the way he keeps track of his patients and their information — the old-fashioned, decidedly low-tech way.
“I have paper office records that I write on,” he said, adding that he does dictations and uses prescription pads.
Unfortunately for Kiteck, that approach isn’t compatible with the demands the government has placed on him in the form of policy changes. Specifically, Kiteck has pointed blame toward the Affordable Care Act (ACA) — more commonly known as “Obamacare,” after the sitting U.S. president who pushed for the legislation.
Kiteck says that the new rules require that he keep records electronically, on the computer. 
Given that Kiteck runs a small business — only three people are on staff — the task of converting all of those paper files seems Herculean.
“Some of those patient records are two inches thick,” said Kiteck. “All the paperwork would have to be scanned. It would take thousands of man-hours — or woman-hours — to scan all those in. They would have to work weekends, overtime, things like that. It’s just unacceptable to have to do it.”
Likewise, he and his staff would have to go through extensive — and expensive — training to operate the new systems.
The total cost, for equipment, training, and extra hours needed to put all records in (about 6,000 in total) electronically? Kiteck estimated about $20,000 — and that may be a conservative figure.
As such, Kiteck decided it was time to go ahead and close his practice rather than face the time and expense of conforming to new regulations.
Kiteck took advantage of the visibility of the Commonwealth Journal to let his patients know about the development. On the first of December, Kiteck started running an ad that would continue for days. It read: “Due to the policies of Obamacare, Stephen Kiteck, MD, will be closing his medical practice on December 31, 2013. ... Dr. Kiteck wishes to thank all his patients that have visited his officer over the past 20 years, and apologizes for this inconvenience.”
Of course, Obamacare is not an uncontroversial topic. With Republicans in Congress fighting to stop it in multiple ways over the past few years — including forcing a so-called “government shutdown” this past October — and criticism of the current administration for the technical glitches plaguing the ACA’s insurance exchange website, the issue of health care reform has found virtually a permanent place in headlines.
As such, Kiteck’s story became a rallying cry for Obamacare opponents, who could point toward Kiteck as an example of the policy’s failures, and an irritation for others more supportive of President Barack Obama’s agenda. The website Buzzfeed.com posted an article called “Here’s Why That Kentucky Doctor is Closing His Practice ‘Due to the Policies of Obamacare.’” The article challenged Kiteck’s use of the term “Obamacare,” arguing that the requirements toward going electronic were actually part of the 2009 federal stimulus act rather than the ACA.
On the other hand, Fox News — often perceived as being a conservative-friendly news outlet — gave Kiteck a chance to talk and explain his side of the story in his own words Tuesday night.
Kiteck’s ad gained attention thanks to pictures of it being shared through the website Twitter. Kiteck isn’t sure how Fox News came to know about his story, but said that some patients had told him they’d called the offices of Congressman Harold “Hal” Rogers about his plight. (Rogers’ spokesperson Danielle Smoot said Wednesday that she was unable to ascertain whether anyone in the office had contacted any media outlets like Fox or not.)
“When they called me and told me it was Fox, I said, ‘Are you sure? THE Fox News?’” he said. “I wanted some proof. ... They said they founds (the story) on the Internet.”
In his interview with Van Susteren on her Fox News Channel show “On the Record,” Kiteck was asked about a provision in Obamacare that would allow reimbursement for the necessary technology upgrades. Kiteck responded that because the money would come on the “back end,” it still wouldn’t do enough to help alleviate the problems facing his business.
“Your computer has to follow a principle that all physicians know is called ‘meaningful use,’” Kiteck told Van Susteren, “which means you have to go through different tiers, tiers of acceptance, and there’s hundreds of requirement in Obamacare for your computer has to follow in order for you to receive the reimbursement two to three years down the road. In other words, you have to put out the full expense up front to invest in your computer equipment, and then later, two to three years later, if you follow the meaningful use of your computer according to Obamacare, then they will reimburse you for that — if the program is still around.”
The term “meaningful use” refers to a specific program that would seek to lower health care costs by upgrading technology and using electronic records to provide more thorough care by providing better access to patient information. The standards are defined through the Centers for Medicare and Medicaid Services.
Kiteck said that doctors like himself are already required to have electronic prescribing capabilities this year, but by the start of 2014, they will also need to be keeping all their records electronically.
Those more favorable to Obamacare have taken the opportunity to criticize Kiteck for his position. An article on the website Daily Kos (m.dailykos.com), started with the line, “The far right is thrilled with this Kentucky doctor crying ‘Get off my lawn!’” and picked up on a quote by Kiteck saying that his office was “computer illiterate,” saying, “Sounds like Kiteck's patients might be dodging a bullet. After all, who would really want a computer illiterate doctor in 2013? Does he know about the Internet?”
Kiteck took the criticism in stride, saying, “It was blown out of proportion, and I understand that. I don’t claim to be a computer expert by any means. I go to my kids every time I have problems with my computer.”
Despite Kiteck’s admitted unfamiliarity with computer systems, his patients aren’t happy to be losing him. 
“It’s very sad, a very difficult decision,” said Kiteck. “Some patients are very upset. It’s very difficult for myself and my staff, but even more so for my loyal patients, some of whom have seen me for 20 years.”
Kiteck have been in independent practice for the last two decades. Before that, he worked with the Family Practice Clinic, from 1978 to 1992.
“I’ve had a lot of very strong comments (made about the decision to close),” he said of his patients, noting that the “negative” comments were never directed at him but at the conditions which have forced his decision. “They’re upset that I’m retiring. I have patients in London, Lexington and Tennessee. The trouble is, I have to call these people and let them know about it because they might not see the newspaper.”
Not that he’s necessarily ready to retire, were all other things equal.
“I would practice into the sunset,” he said. “I would continue for another four or five years if I didn’t have to make the conversion.”
He thinks that the regulations will be easier to handle for a larger group of physicians, like those in the Medical Arts facility here in Somerset.
“They could probably do this, and most larger practices already have (electronic record keeping),” he said. “I can’t speak for them. I can only speak for the situation I’m in.”
That said, Kiteck expects the policies could hurt a number of smaller solo practices.
“For young solo practitioners just starting out, it’s easy for them. They’re starting from ground zero,” he said. 
However, he’s not even sure that solo practitioners will exist in another 10 years before of all the expenses and the monthly fees required by the new rules.
“I just feel that most will be wary of going into practice by themselves,” he said. “They may want to join a group practice where (the systems) are already there. They can just walk in with their stethoscope and start practicing.”
Kiteck is giving his patients a list of other doctors in the area who may be able to help them before he closes for good on December 31. He believes they will be in good hands, even with less personal outfits than his own.
“I think patients will get taken care of very well,” he said. “The larger practices can afford to upgrade as the law requires.”