Medicare increase still won't cover most doctor fees: BOTTOM LINE Many seniors can't find physicians to treat them.

George Bryson

Jul. 19, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- Action by Congress this week to sharply boost Medicare reimbursements for Alaska's seniors caused a triumphant Sen. Ted Stevens to laud the bill's success:

"This increase will help open the door to doctors' offices for seniors across the state," Stevens said in a press statement.

But will it?

Older Persons Action Group staffer Rita Hatch of Anchorage says she's hopeful -- but skeptical. Each day she takes calls from frustrated senior citizens who can't find a family doctor in town willing to take new patients on Medicare, the federal health care plan for people 65 or older as well as younger Americans who've suffered a disability.

They ask her if she can suggest anyone. Her answer is always the same. "In Anchorage there are eight doctors who take new Medicare patients and they're all at the Anchorage Neighborhood Health Center," Hatch said this week, echoing her standard reply.

What about the 750 or so family physicians in Alaska in private practice?

Hatch doesn't know any of them who openly welcome new Medicare patients. They tell her they can't afford to take on more high-needs seniors when the government fails to adequately reimburse them.

The new law, which Congress passed over the president's veto, blocks a 10.6 percent reduction in Medicare reimbursements nationwide -- a scheduled cut that Stevens and Alaska Sen. Lisa Murkowski warned would hurt senior Alaskans seeking health care. But Stevens also managed to include a provision to permanently raise Medicare payments in Alaska by 35 percent.

Will the bump up change the doctors' minds?

"It's significant, and hopefully it's going to help," Hatch said. "But we won't really know until January -- when the bill takes effect."

He's hopeful too, says Dr. Thomas Vasileff, president of the Alaska State Medical Association. But he doubts whether a 35 percent increase to a relatively tiny Medicare reimbursement will do much to change the status quo.

"It's really good that it happened -- I think it prevented a major catastrophe, if indeed the 10 percent reduction had gone into effect," Vasileff said. "But in terms of it reversing the problem with getting physicians to see more Medicare patients, I think that issue is still there."

THE BOTTOM LINE

For many family doctors it boils down to a simple calculation, in which the government only reimburses them a quarter to a half of what they would have charged a non-Medicare patient.

"For most procedures it's like a 25 percent reimbursement," Vasileff said.

So instead of the doctor getting paid $100 for a particular service, the government pays $25. Increasing that number by 35 percent will only raise the reimbursement to $33 -- about a third of a standard charge, Vasileff said.

In terms of his own practice -- and those of most medical specialists like him -- the doors are still open to Medicare patients, he said. But bottom-line calculations are often more critical for family practices, where overhead costs are higher due to the need to maintain more equipment and more employees.

Some local primary care doctors quietly accept Medicare coverage from long-time patients who "age in" to the system. But about 60 physicians statewide have officially opted out of the Medicare program entirely-- a move that forces them to care for older patients on a cash-only basis (though some seniors have "secondary insurance" that covers part of the gap).

Among the latter are doctors with Primary Care Associates in Anchorage, the largest family practice in the state.

"There are no good choices (for older patients), but there are some less bad choices," says Dr. Bruce Kiessling at Primary Care.

Since officially cutting ties with the Medicare program in February -- partly in anticipation of the scheduled Medicare cutback, partly due to a demographic surge of older patients in a suddenly aging Alaska -- his practice has been working individually with affected patients to lower their fees.

Seniors who've been with them for more than three years get a 25 percent reduction off the top, along with a sliding fee scale based on income, Kiessling said.

Primary Care Associates made similar allowances a few years back when it opted out of Medicare once before, and during that period nearly all of their Medicare patients opted to stay with them, said Dr. Mary Ann Foland, another physician at Primary Care.

"We all have patients that we've known for years and years who are having a hardship, and we look at each of those on a case-by-case basis," Foland said. "And I would bet you that most of the family docs in town do the same."

SWAMPING THE CLINIC

Among those offering perhaps the least expensive medical care in town are physicians at the Anchorage Neighborhood Health Center, a federally subsidized clinic. As such the center is obligated to remain open to all Medicare patients.

And that could be a problem, if the "opt-out trend" in Anchorage continues to the point where the clinic becomes the only destination in town for seniors covered solely by Medicare, according to ANHC director Joan Fisher.

That's why she welcomes the passage of the Medicare improvement bill, even though the clinic will only receive a small bump in funds (since it receives its Medicare reimbursements through a different formula).

"Even though we won't get the money, we're very excited about this increase because we're hoping that private physicians in the community will either re-enroll in Medicare or bump up their Medicare participation," Fisher said.

"Because we're getting down to being the only provider in Anchorage taking new patients -- and we just don't have the capacity."

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Find George Bryson online at adn.com/contact/gbryson or call 257-4318.

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Typical doctor's visit*

--$140 -- What doctors normally charge, according to Anchorage Neighborhood Health Center director Joan Fisher

--$63 -- Amount government is now willing to reimburse doctors for Medicare patients getting same service (about 45 percent of normal charge).

--$85 -- New amount government will reimburse doctors for same service, beginning in January (about 60 percent of normal charge).

--$55 -- Amount doctors "lose" per patient visit through Medicare, compared to standard fees.

* Based on average visit for "established patient," using Medicare reimbursement code No. 99213.

Newstex ID: KRTB-0009-26783585