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Consumer Reports


Docs shunning Medicare patients due to low reimbursements

http://www.jewishworldreview.com | (KRT) For most of her life, Carol Senal never fretted about finding a doctor. Her father was a doctor, her ex-husband is a doctor and her son is a doctor.

But after moving to Chicago from New York earlier this year, Senal, 67, was snubbed by two physicians, who refused to take her as a new patient because she relies on Medicare, the federal health-insurance program for seniors, to pay her bills.

The problem is simple: Medicare doesn't fully repay doctors for treating its patients, as the program's reimbursement fees haven't kept up with doctors' soaring costs. Medicare's physician reimbursements have been cut in recent years and are due another 4.2 percent cut next year to help control government outlays for the cash-strapped program.

Doctors say the low reimbursement rates are artificial price controls that threaten to drive them out of business. Rather than be underpaid, more family doctors are just saying no to new Medicare patients such as Senal. The trend has created a nationwide access-to-care problem for thousands and thousands of seniors who have relocated or seek new doctors.

"Moving from New York was an upheaval, but to have to go through hell to get a doctor is crazy," said Senal, who has high blood pressure. "I am just in a total fury. It has been a terrible experience."

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The frustration runs both ways, said Dr. John Sattenspiel of Salem, Ore.

For routine office visits in which he treats several different ailments, Sattenspiel charges $85. Medicare pays $38.25 for such visits. For more complicated office treatments, Sattenspiel charges $124. Medicare pays him $59.50. The shortfall, he said, has forced him to spurn new Medicare patients.

"It's a real frustration when patients who have an elderly parent moving to town call and ask if I'll take their parent into my practice and I have to very politely decline," Sattenspiel said. "We're barely at break-even when we see these patients."

Doctors want Congress to increase their reimbursements in the Medicare prescription-drug bill that's expected to emerge this fall from a Senate-House of Representatives conference committee. The House proposal would replace the planned 4.2 percent reduction with modest increases of 1.6 percent in 2004 and 2005. The Senate bill also calls for increases, but offers no figures.

The outcome is especially important for family doctors such as Sattenspiel who aren't specialists but provide the bulk of care for Medicare recipients, who often have multiple chronic conditions.

Sattenspiel's payment shortfalls with Medicare help explain why more than 1 in 5 family doctors - 21.7 percent - don't take new Medicare patients, according to a 2002 survey by the American Association of Family Physicians. That's up from 17 percent, or 1 in 6 doctors, in 2001.

Very few physicians have stopped seeing their longtime Medicare patients, but the revenue pinch may be affecting care.

"The big thing I keep hearing from family doctors is `I can't keep nurses and my office staff' or `I can't compete for the quality people that I need,' " said Dr. Warren Jones of Jackson, Miss., the board chairman of the American Association of Family Physicians. "We're not talking about reimbursing for services that would allow family physicians to go out and buy new airplanes and boats. We're talking about keeping offices open and staffed."

Dr. Arthur Snow of Shawnee Mission, Kan., has cut his office hours from five days a week to two because his Medicare-heavy patient load doesn't pay enough to fully staff and operate an office. He visits patients in hospitals and nursing homes to save on overhead.

In Sanford, N.C., Dr. Robert Patterson canceled plans to buy a $30,000 blood analyzer because Medicare would pay him only $3 to draw blood and discuss the test results with patients. "I can't afford to talk to you for very long for three bucks," Patterson said.

The House and Senate Medicare provisions call for changing the formula Medicare uses to determine those payments. The current formula bases payments on four factors: medical inflation, growth in Medicare enrollees, the change in payments created by new laws or regulations and projected annual growth in the gross domestic product, the total value of goods and services produced in the country.

Doctors blame the GDP's poor performance for dragging reimbursements down, and they want the formula to use a more stable economic indicator.

The House bill would replace the annual GDP projections with a 10-year rolling average that would mute the volatility of annual changes. The Senate bill calls for similar changes.

Fueled by a strong economy between 1998 and 2001, Medicare's reimbursement formula provided increases of 2.3 percent, 5.5 percent and 5.9 percent. But as the GDP faltered, the payments decreased by 4.8 percent in 2002. After heated protests from doctors, Congress reversed a planned 4.4 percent cut for 2003 and hiked payments by 1.6 percent.

Unless Congress intervenes again, next year's projected 4.2 percent cut could force more doctors to shun new Medicare patients.

That's a disturbing prospect, said Senal of Chicago: "Will I have to go around on my knees begging for a competent doctor if that happens?"

___

The Medicare Rights Center, a national, not-for-profit organization that helps ensure that older adults and people with disabilities get good affordable health care, has information about Medicare and seniors on its Web site, www.medicarerights.org

AARP, formerly the American Association of Retired Persons, is the nation's leading advocacy group for older Americans. Its Web page for Medicare coverage issues is www.aarp.org/healthcoverage/medicare

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