Medicare muddles search for a physician
Low reimbursement rate in region makes some doctors refuse new patients
Wednesday, August 17, 2011
When Helen and Rick Gill moved from Pensacola, Fla., to Clark County four years ago, one of the tasks on their to-do list was to find a new primary care doctor.
That turned out to be more difficult than anticipated. The couple, both in their 70s at the time, were on Medicare and surprised when one physician’s office after another turned them away.
“We could not find a doctor for a long time,” said Helen Gill. “I don’t know how many doctors we called. We just went down the Yellow Pages, and each one said they don’t accept Medicare.”
The Gills’ predicament illustrates a long-standing trend of seniors who struggle to find a primary care physician who accepts Medicare. The difficulty, which is more concentrated among seniors who have moved to a new area, results from federal policy that compensates providers at significantly lower rates than private insurance and pays them differently according to which region they practice in. In primary care, where office visits represent the bulk of services, the reimbursements often don’t cover the cost to the provider to provide services, some Clark County physicians said.
Medicare reimbursement tends to be lower in the Pacific Northwest than in the rest of the nation, said Andrew Tartella, an external affairs liaison at the Seattle office of the Centers for Medicare & Medicaid Services. Washington, Oregon and Idaho have been particularly efficient in providing health care compared with some other states, Tartella said. Medicare reimburses providers based on the cost to provide health care in their respective state, so the states’ lower costs have resulted in lower payments, he said.
Exacerbating the problem is the constant threat of reimbursement reductions written into federal policy.
In Clark County, the patient-to-physician ratio is lower than the state and national average, meaning, in theory, it should be easier to find a doctor. And the majority of seniors The Columbian interviewed said they had not had a problem finding a primary care physician.
“I’ve been on Medicare for 19 years, and I’ve never had a problem finding a doctor,” said Vancouver resident Jerry Benjamin, 84. “I’ve had good luck with all my doctors.”
But some Clark County seniors have had difficulty, especially those who are newcomers to the area. Some had even been dropped by their doctor because they were on Medicare.
Vancouver resident Cathy Wampach, 88, said a Portland doctor she’d been seeing suddenly stopped taking Medicare.
“I never had a problem; he accepted Medicare before,” Wampach said. “All of a sudden, I got a bill. I quit going to him because he wouldn’t accept Medicare.”
In 2009, about 72 percent of 6,200 physicians surveyed in Washington were accepting new Medicare patients, according to a February 2009 survey by the Washington State Medical Association. Out of the 29 percent who were not taking new Medicare patients or had decided to drop them, 79 percent said it was due to low payments.
Regional differences in Medicare reimbursement could play a role in why Clark County and other Pacific Northwest residents might have trouble finding a doctor who accepts Medicare.
The average Medicare payment in the Portland hospital referral region, which includes Clark County, was $5,278, compared with a national average of $6,611, according to a 2007 analysis by the Darthmouth Institute for Health Policy & Clinical Practice. Reimbursement rates were even lower in other parts of Washington and Oregon.
Dr. Donald Benz, a Vancouver primary care physician, said he keeps seeing his patients when they become eligible for and enroll in Medicare, but he has not accepted new Medicare patients for the past eight years.
“The reason is this: the Medicare payment is (half) of the bill charges,” Benz said. “We cannot make a profit seeing Medicare patients.”
Office services “are the bread and butter of primary care,” but Medicare payments for office visits and related services, such as a pneumonia shot, are scanty, Benz said. He charges $202.40 for a 30-minute office visit. Medicare reimburses him for just $101.06 of that.
A typical primary care office overhead can run between $200 and $300 per hour, excluding the cost of the provider, Benz said.
Another reason some physicians might not accept Medicare is the amount of hassle involved in filing a claim, he said.
“When you submit a claim, if it’s not done exactly the way they want it, they reject it,” he said. “If you call and ask what’s wrong, they say, ‘We can’t tell you how to bill.’ We have to comb through the fine details of the law to figure it out. It’s very frustrating. You could go through 286 pages of legalese, and it still doesn’t tell you how to bill for it.”
Physicians also never know from year to year whether Medicare reimbursement rates might plummet. A federal formula written into law triggers automatic reductions each year in Medicare payments. Congress, however, has frozen the rates each year to prevent an exodus by providers from the Medicare system.
A 21 percent decrease in rates was scheduled for January, but in fall 2010, Congress put a freeze on the rates. Another decrease of 29 percent could go into effect this January if Congress doesn’t act, said Jennifer Hanscom, associate executive director of the Washington State Medical Association.
“This has happened over and over, and each time, Congress just puts a Band-Aid on it,” said Ingrid McDonald, advocacy director at AARP Washington.
“The problem is, it’s expensive to solve,” McDonald said. “I think Congress is reluctant to lock into any new formula that results in a higher level of commitment.”
Providers that accept Medicare often try to balance out the number of those covered by Medicare and Medicaid and those with higher-paying private insurance. That helps to make up any financial losses and keep offices profitable.
“A lot of doctors see Medicare patients, but they restrict the numbers,” said Dr. Douglas Myers, a Vancouver internal medicine doctor and president of the Washington State Medical Association. “Most see existing patients who become eligible for Medicare but won’t see new ones.”
As a result, it’s difficult to determine how accessible providers actually are to Medicare beneficiaries.
Legacy Health, with four primary care clinics in Clark County, is an example of the difficulty in tracking numbers. Legacy Health clinics in Battle Ground and Fishers Landing restrict providers to accepting one new Medicare patient per week, said spokesperson Brian Willoughby. Salmon Creek Family Medicine varies according to physician. Each physician accepts one to three new Medicare patients each week, while Salmon Creek Internal Medicine isn’t accepting any new patients.
The ratio of Medicare beneficiaries to Medicare doctors in 2009 was about 69-to-1 in Washington state, considerably better than Oregon’s ratio of 76-to-1 and the nation’s, 73-to-1, according to the Center for Medicare & Medicaid Services. What’s unknown is how many Medicare patients each doctor took, and how big the demand was.
Marie (Kern) Feenan of the Clark County Medical Society, said she receives an average of a dozen calls per day asking for names of doctors who accept Medicare. She usually directs them to Providence Medical Group and Sea Mar Community Health Center, a federally-funded, community-based clinic.
When possible, experts recommend that people find a primary care physician before they become eligible for Medicare. Once accepted by a doctor, it’s unlikely a patient will be dropped because he or she becomes eligible for Medicare.
Medicare recipients who move to a new area should lvisit www.medicare.gov to find a doctor who accepts Medicare.
Another strategy is to obtain a Medicare Advantage plan, which provides better compensation to doctors, McDonald said. Plan costs vary by insurer. Some plans offer low or no premiums, but patients are often limited in which providers they may use.
If all else fails, try going to an urgent care clinic for care. Some doctors at urgent care clinics will agree to serve as a primary care physician after they’ve treated a patient once.
That was how the Gills finally found a primary care physician. Rick Gill had some alarming heart symptoms and had to go to Urgent Medical Clinic at Salmon Creek. A doctor at the urgent care clinic connected the couple with another doctor at the clinic, Rick Nicoski, who agreed to serve as their primary physician.
“We didn’t know that would help us find a doctor, but evidently it did,” Helen Gill said. “It’s really hard here. In Pensacola, Fla., we never heard a doctor mention it. It was never a problem there.”
They found Nicoski in the nick of time. The clinic recently stopped accepting new Medicare patients for financial reasons, Nicoski said.
“When someone finds out you are open to Medicare patients, you are inundated because hardly anyone is accepting new Medicare patients,” Nicoski said. “If you do, the floodgates open.”