The amount and coverage reductions cause Doctors to quit taking new patients.

http://www.medequote.com/insurance/medicare.html

Doctors fleeing Medicare, Medicaid

By Carol M. Ostrom
Seattle Times staff reporter

On a recent visit to the Edmonds Family Medicine Clinic, Curtis Wiggins was shocked to find a flier announcing the clinic will no longer take new Medicare patients.

It made him so angry he started calling and writing his elected officials.

What's going to happen to retired and disabled people? demanded Wiggins, who is 63 and soon will be eligible for Medicare. "Why don't we put 'em in an incinerator and burn them up, if nobody's going to take care of them?"

The 26-doctor Edmonds facility is among clinics and practices around the state closing their doors to new patients insured by Medicare, a federal health-insurance program for retirees and disabled people.

Many clinics also are refusing to take new patients receiving Medicaid, a state-federal insurance plan for low-income residents.

Doctors and clinic managers say they're losing money on reimbursements from these public programs as their costs rise. They are no longer able to shift costs to private insurers, they say, and must limit Medicare and Medicaid patients in order to stay solvent.

Federal and state officials counter that Washington's doctors aren't any worse off than those in other states when the complex formulas governing these rates are decoded.

There is no definitive truth yet, and no statewide statistics on clinic closures. But local medical officials, pointing to an effective cut this year of more than 5 percent in Medicare reimbursements, say the anecdotal evidence points to a growing crisis, particularly outside the Seattle area.

Clinics respond


Here is a sampling of what some clinics around the Puget Sound area are doing in response to what they say are inadequate Medicare and Medicaid reimbursements:

• The Polyclinic: 85 doctors, about 25 of them in primary care. Most primary-care doctors are not accepting new Medicare patients, unless they're on Secure Horizons, a Medicare managed-care plan. All specialists and a few new primary-care doctors are taking new Medicare patients. All doctors are taking new Medicaid patients.

• Minor & James: 70 doctors, 22 of them primary care. Limiting, but not barring, new Medicaid patients. More cuts in Medicare reimbursement, said Lowell Doyle, administrator, will likely precipitate a discussion about barring or limiting new Medicare patients.

• Virginia Mason Medical Center: 400 doctors. Takes new Medicare patients, except at its Port Angeles Clinic. Not taking new Medicaid patients in primary-care practices.

• PacMed Clinics: 120 providers, including primary- and specialty-care doctors, nurse practitioners and physician assistants. Accepts new Medicare patients in primary-care practices but limits new Medicaid patients.

• Group Health Cooperative: About 1,200 doctors, mostly primary care and pediatric, around Puget Sound. Open to new Medicare patients in King and Pierce counties; limits in Skagit, Whatcom and Kitsap counties. No new Medicare patients in Snohomish County. New Medicaid patients accepted in King, Kitsap, Pierce, Snohomish and Spokane counties.

Thurston County doctors

In Thurston County, not a single doctor will take new pediatric patients insured by Medicaid, says Dr. Doug Green, president of the Thurston-Mason County Medical Society.

A large Olympia clinic went bankrupt last year, and patients flooded the remaining doctors. As a result, many aren't taking any new patients, even those paying with cash, Green said. "It's quite frightening."

In Spokane, the largest clinics have all decided to stop taking new Medicare and Medicaid patients, said Jan Monaco, CEO of the Spokane County Medical Society.

Last week, Madrona Medical Group, the largest medical group in Whatcom County, with 50 primary- and specialty-care doctors, decided to bar new Medicare and Medicaid patients.

Many doctors say they think political pressure from angry Medicare and Medicaid patients is their only hope of persuading elected officials to change public insurance rates.

"Part of the reason doctors are closing (their doors) to Medicare is they can't think of a single solution," said Dr. Paul Buehrens, one of 22 physicians at Lakeshore Clinic in Kirkland, which stopped taking new Medicare patients last spring. "But part of the solution will be that Medicare patients will find themselves with nowhere to go and they'll start screaming."

Many practices began taking a hard look at their finances after the demise last spring of Memorial Clinic in Olympia, a 51-year-old multispecialty practice that at one time included about 90 doctors.

Then, last fall, Everett Family Practice Center, a 24-year-old practice once composed of 14 doctors, shut down. This year, a 19-year-old women's health-care practice in Everett dissolved.

"Let's face it, doctors are lousy businessmen," Buehrens said. "Any good business should have had the financial depth to analyze what they were doing, and see this coming. But medical groups run on a shoestring and they always have."

Lakeshore managers last year took a hard look at reimbursements vs. the cost of services, and what they found stunned them: Every patient visit reimbursed by Medicaid lost the clinic $25; every visit reimbursed by Medicare, $10.

"It was truly charity care. You could pay patients to go away and save money," Buehrens said.

Edmonds Family Medicine Clinic struggled with the same issue and came up with similar figures, said CEO Marcy Shimada.

On Jan. 1, after calculating the clinic was losing $10 per Medicare patient visit, the Edmonds clinic closed to new Medicare patients. It hadn't taken on new Medicaid patients for several years.

Both Edmonds and Lakeshore say they'll continue to see current patients.

Medicare and Medicaid facts


Medicare:

• Federal health-insurance program for people age 65 and older and those with severe disabilities.

• About 40 million people insured nationally, and 725,000 in Washington state, according to estimates by the Centers for Medicare & Medicaid Services.

• Reimbursement: Formula is set in federal law, requiring congressional action. The formula looks at a number of factors, including the time it takes a doctor for the given visit or procedure, overhead costs such as office rent and labor, malpractice-insurance expenses and cost adjustments by locale.

Medicaid:

• A state-federal health-insurance program for low-income and disabled residents, including children.

• About 920,000 enrolled statewide as of January; about 434,000 of those are enrolled in a managed-care plan called Healthy Options.

• Medicaid is now about 17 percent of Washington state spending, and projected to increase by 11.6 percent a year between 2000 and 2003, according to a 2002 report by the Urban Institute.

• Reimbursement rates are set by the state Legislature and the Department of Social and Health Services.

But the decision has been hard on patients who are trying to find a doctor now.

"When people come to us, they've called two or three other offices. They're finding it harder and harder to find some place to go," Shimada said.

Some patients have begun lying to clinics, saying they're private pay when they're actually insured by Medicare, said Carol Stevens, CEO of Lakeshore Clinic.

The patients pay cash but then ask Medicare for reimbursement. But Lakeshore's doctors, because they are continuing to see existing Medicare patients, are barred by law from accepting cash from any Medicare patient, said Pam Negri, spokeswoman for the federal Centers for Medicare & Medicaid Services (CMS).

When Lakeshore found out about the deception, the clinic refused to see the patients in the future, Stevens said.

So what are patients covered by Medicare or Medicaid supposed to do if they move to an area where they can't find a doctor?

"Go somewhere else for care or move," Negri said

Bush's new health care plan? Really? How much faith can I put in the word of someone who doesn't even know who our President is? :)

Hey, what can I say.

Bush gets blamed for all O'Bumbles screw ups, nay as well blame him for this one to.

Oddly Germany's answer to the problem was to make health care and insurance NON-PROFIT. There is a reasonable wage standard imposed so that the people working for these organizations are adequately paid for their services and expertise. Also German Health care DEMANDS total transparency. Billing must be to the point and not hidden behind code like it is here. Rates and fees must be listed openly like a menus when you go to a restaurant.

Germany's health care system works and their doctors have no complaints nor do the citizens of Germany. This goes against the grain in the UK and Canada where there are shortages of doctors and nurses, High taxation, and long waits to get treatment.

America's health care albeit the best in the world as far as quality of service goes is for profit and rapes consumers becasue of the need people have for health care. If health care is so important to us why not make it non-profit? Funny thing is MANDATORY INSURANCE! When ANY industry becomes Mandatory they suddenly become excessively expensive. Look at Auto Insurance!

Now that Health Care Insurance is mandatory just watch! I can't afford to pay for it! Now I am going to get penalized at every turn for it? F BUSHBAMA! F HIM IN HIS EAR!

BUSHBAMA IS JUST SELLING US OUT DEEPER AND DEEPER!

Get ready to start speaking Chinese.

I would also like to say that I love how people reacted to Bush during the 9-11 crisis. I was a little dismayed but then again he was in a a classroom full of children. What was he supposed to do? Freak out on them? He played it cool if anything.

Obama sold us out to the Health Care Industry and the insurance Industry! They already have plans to adapt to the "NEW AND BETTER HEALTH CARE PLAN!" MARK MY WORDS IN RED!

Cough Cough, I mean Bushbama!