Medicare Doctors In Rural Areas Are Waning
According to an article by Ken Alltucker on Jan. 24, 2010 in The Arizona Republic seniors in rural Arizona towns and cities with a graying population, such as Yavapai County’s Prescott and Prescott Valley, are facing what health officials acknowledge is a troubling trend: doctors who refuse to see new Medicare patients.
Many seniors have struggled to find a local physician and have turned to hospital emergency rooms, clinics or lengthy car trips to Phoenix for health care. Medicare, some doctors say, pays too little, and the red tape is too much. According to a June 2008 report by the Medicare Payment Advisory Commission, nearly a third of Medicare recipients looking for a new primary-care physician had some trouble securing a regular doctor.
Medical professionals say the Prescott area may serve as a valuable lesson for the nation as Congress seeks to expand health care: Even if most Americans are covered under some form of insurance, many still may not find a doctor willing to see them. Because there is a shortage of primary-care doctors, they can afford to be choosy when taking on new patients.
Tom White, 72, moved to Prescott Valley from Sacramento more than five years ago. He called doctor after doctor as he sought to land a slot for a checkup. When he said he had Medicare, the government’s insurance program mainly for those aged 65 and older, he was repeatedly told to find another doctor. "It was like filling out a job application," White said. "They looked it over for a day or two, and then they tell you they don’t want you."
Primary-care doctors, who provide the basics of care such as conducting annual exams and monitoring chronic conditions like diabetes and high blood pressure, say they face an annual fight with Congress for their share of Medicare dollars. The payment system is governed by a Clinton-era funding formula known as the sustainable growth rate. Congress has yet to fix the basic funding formula which says that Medicare payments to doctors for the typical patient can’t exceed the growth of the overall economy. While this worked during flush economic times, doctors faced their first payment cuts in 2002. Each year since, Congress has halted proposed pay cuts and approved one-year fixes with nominal pay increases.
2010 Medicare threatened a pay cut for doctors of 21.5 percent, only to give doctors a two-month reprieve that will expire at the end of February. Some health-management companies recommend that doctors don’t see Medicare patients at all.
A research of John Moyer, chief executive of Yavapai Management Innovations in the Prescott area, shows that area doctors get about 55 cents for each $1 billed based on standard fee schedules. Moyer said it doesn’t make sense for his doctors to see Medicare patients because of the lower reimbursement rate.
Longtime Prescott physician Bill Thrift agrees. He said Medicare’s lower pay and the cost to hire office workers to process the paperwork makes little financial sense. Thrift said he will not drop his longtime Medicare patients. However, when new Medicare patients call, chances are they won’t get a slot. "It’s getting to be every time I see a (Medicare) patient, I lose money," Thrift said. "So I can’t really make it up in volume."
Prescott-area health officials acknowledge a doctor shortage, but they also say that the reality may not be as bad as some believe. Seymour Dicker, who oversees service, said he knows of a dozen doctors in Prescott who will take new Medicare patients. He believes most people having difficulty finding a doctor grow frustrated with their search because they look in the phone book or call doctors based on referrals from friends or family.
Chino Valley residents Roger and Bonnie Mahon however can attest to the difficulty in finding a primary-care doctor in the area. Bonnie’s longtime doctor, Douglas Campbell, sent a letter about two years ago to his patients informing them he would no longer take Medicare patients because of the low reimbursement. Her husband Roger gave up his search for an area doctor several years ago. He commutes 220 miles round trip from Chino Valley to Phoenix to see a doctor, often getting a hotel room in the Valley overnight because of the long drive. When Bonnie initially sought to replace her doctor, she was told by other physicians that it would take up to 10 months for an appointment. She, too, traveled to Phoenix for doctor’s appointments until she recently found a replacement doctor in Prescott.
It is hard to blame a doctor who has the ability to charge higher rates to accept people with plans that pay these rates. Money rules, that is the sad truth. Once again, having private insurance like a Medicare Advantage Plan, is more important than ever before.
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