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A Medicare Mess: Part 2

by Mike Ross
Tuesday, Nov. 20, 2007

The physician's perspective

ANCHORAGE, Alaska-- Many senior citizens are facing a frustrating and potentially dangerous situation: they can't find doctors in Anchorage willing to take them as patients because they're on Medicare.    

J.R. Edwards is just one of many seniors in Alaska who've recently learned that turning 65 and transitioning to Medicare health coverage might result in difficulty finding a primary care physician.

"My normal health care provider, after 15 years told me she had opted out. If I wanted to see her in the future, I would have to pay," Edwards said. "If I pay, then I can't bill Medicare -- that's strictly out of my pocket."

On the other side of the equation, local doctors are explaining why they must turn away the elderly.

"We're caught between trying to provide services for patients and trying to run a business," said Alaska State Medical Association President Dr. Ross Tanner.

Doctors say running a medical practice in the Last Frontier is much more expensive than in the rest of the country.

"It costs 65 cents on the dollar to care for a patient, and Medicare reimburses 22 to 35 cents on the dollar," Dr. Paul Davis, president of the Alaska Academy of Family Physicians said. "Salaries are higher (in Alaska), equipment costs are greater and you have to pay the rent."

Doctors say efforts in Washington D.C. to control Medicare costs leave them shortchanged.

"The costs were so exorbitant and the fees were so low for the reimbursement for Medicare patients, at the end of the day I could actually owe money for working a ten hour day," Dr. Ross said.

If an Anchorage primary care doctor's fee for an office visit is $130, Medicare will only allow a maximum charge of $67.  

Medicare then pays 80 percent of that, meaning the doctor only gets paid $53.60 of the original $130 fee.   

Under federal law, patients and their private insurers are not allowed to make up the difference between Medicare's maximum allowable charge and the doctor's original fee.    

Specialists, like gastroenterologist Dr. Richard Farleigh, say they face the same problem.

Dr. Farleigh charges $1,128 dollar for a colonoscopy, which doctors say is a vital cancer screening test for elderly patients.

Farleigh says that of that $1,128 fee, Medicare will only reimburse $164.

"You're going in the hole on every patient that you see," he says.

During a special congressional hearing in Anchorage earlier this year, Sen. Lisa Murkowski focused on what she says is another part of the problem - the growing shortage of physicians in Alaska.

"We need to bring in some additional 49 doctors, medical professionals to this state, every year," said Murkowski, R-Alaska. "We are so woefully behind that I think it does merit the term 'crisis.'"

To try and attract doctors, Murkowski has introduced the Rural Physicians Relief Act, which would provide tax credits for primary care doctors who provide services in the Bush.    

The bill is still pending in Congress.   

Murkowski would also like Congress to provide more funding to increase Medicare reimbursements to doctors.

Unless Congress steps in, Medicare reimbursements to doctors are set to be cut by about 10 percent in 2008, making it even less likely that doctors will change their minds about turning away the elderly.

Senior's advocate Rita Hatch says doctors and the government each need to give in a little for the sake of the elderly.

"Medicare doesn't pay enough but doctors charge too much," Hatch says. "If Medicare would come up in their payments a little bit and doctors would come down in their charges a little bit, it would be fairer."      

Everyone seems to agree that the solution to Alaska's Medicare mess can only come from the nation's Capitol.

"I think the solution is not just Band-Aids and patches for Medicare. I really think our legislators in Washington D.C. need to realize the severity of the problem." Dr. Davis says.

Meanwhile, the problem is leaving many of Alaska's Medicare patients wondering if anyone really does care.    

Seniors and doctors both agree that people under 65 years old should also be concerned about this problem.

Right now, the number of Alaskans who are 65 or older stands at about 6.8 percent of the state's population. The Alaska Department of Labor estimates that by 2030, the number of senior citizens will grow to almost 13 percent of the state's population.      

If a solution isn't found, thousands of additional Alaskans could face this Medicare mess.     

Gov. Sarah Palin's Health Care Strategies Planning Council will meet soon and this is expected to be one of the issues discussed.

The Council will be meeting Dec. 3, 2007 at the Sheraton Anchorage Hotel. Public testimony will be accepted by the Council from 1:30-3 p.m. and 5:30-7 p.m.

Health officials say this is a golden opportunity for the public, not just seniors, to let the governor know what they would like Alaska's health care system to look like going forward.

Officials say the testimony will also help them determine what issues the state should prioritize.

Contact Mike Ross at mross@ktuu.com