Copyright 2002 The Times Mirror Company; Los Angeles Times
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November 4, 2002 Monday Home
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14; National Desk
LENGTH: 1854 words
HEADLINE: The Nation; Seniors See a
Doctor Shortage; Lower Medicare reimbursements are causing a
worsening; problem for the elderly, as they scramble to find
physicians.
BYLINE: Vicki Kemper, Times Staff
Writer
DATELINE: BOULDER, Colo.
BODY: With its excellent public services, rich
cultural offerings and fall afternoons that glisten like gold in a prospector's
pan, it is no wonder that this outdoor-recreation mecca has also become a
retirement paradise.
But for transplanted and local
retirees alike, getting to see a doctor can be even harder than registering for
one of Boulder's overbooked computer classes for seniors. Medicare cards, long
considered a guarantee of health care in old age, are proving little better than
fool's gold.
Because the Medicare program has reduced
the amount it reimburses doctors, many seniors now have to make as many as a
dozen phone calls just to find a physician who is still accepting new Medicare
patients. Others were dropped by their longtime doctors when they turned 65.
"Seniors are going without care, and patients are getting sicker," said Jim
Peters, vice president of Boulder Community Hospital. "We are close to a
crisis."
Colorado is merely one of the more dramatic
examples of a trend that is sweeping the country and threatening to undermine
Medicare. Many Medicare cardholders have supplemental insurance for prescription
drugs and other uncovered expenses, but since its enactment in 1965, Medicare
has provided basic health benefits for all senior and disabled Americans.
Until now, at least. The aging of the population --
combined with escalating health-care costs, cuts in Medicare reimbursements,
problems with Medicare HMOs and political gridlock in Washington -- is producing
a physician shortage so severe that social service agencies in some communities
now count Medicare beneficiaries with the homeless and the uninsured as being
"medically underserved."
The nonpartisan Center for
Studying Health System Change recently found that about 1 in 9 Medicare
beneficiaries reported delaying care or being unable to find a physician last
year -- before this year's 5.4% cut in physicians' fees took effect.
And with the announcement expected soon of a 4.4% cut for
next year in Medicare payments to doctors, the situation is likely to get even
worse.
"If Congress does not reverse the cut, you will
see a perfect storm," said Dr. Jeremy A. Lazarus, a psychiatrist and president
of the Colorado Medical Society. "Physicians will stop seeing even current
Medicare patients."
A bill to restore billions of
dollars in reimbursements to doctors is pending in Congress, but action this
year appears unlikely.
Lawmakers focused their
election-year attention on demands by the 35-million-member AARP and other
senior groups that Medicare begin covering prescription drugs. But the Senate
could not agree on the details of a drug benefit, and when lawmakers in
mid-October appeared on the verge of reversing some of the fee cuts for doctors,
Sen. Olympia J. Snowe (R-Maine) prevented her colleagues from doing one without
the other.
The action left many Colorado physicians
shaking their heads.
"We're not talking about big money
compared to a prescription drug plan," Denver geriatrician Christopher Unrein
said of Medicare reimbursements. "If you don't have someone to write the
prescription, what good does a benefit do you?"
But on
Denver's north side, where a handful of Democratic candidates appeared last
month at a forum organized by AARP members, prescription drugs topped the
agenda.
"I was more than disgusted" when Congress
failed to pass a Medicare drug benefit, said Elsie Johnson of Lakewood. The
69-year-old joined a Medicare HMO that helped her pay for her many medications
for diabetes, osteoporosis, high blood pressure and a thyroid condition. She
said she would vote against GOP Sen. Wayne Allard on Tuesday despite being "a
Republican from way back."
For most of the 75 seniors
at the forum, concerns about access to doctors were lost in rhetoric about
Social Security privatization and drug companies' political influence.
Yet seniors' representatives and patient advocates know
the problem is real. They believe that as more Medicare beneficiaries are turned
away by doctors' offices, they will begin to make a connection between their
inability to find a physician in Colorado and their representatives in
Washington.
Some already have.
Vi Bowers, slight but sharp in her blue AARP vest, recently had a hard
time finding a gynecologist and an ophthalmologist in the Denver suburb of Wheat
Ridge. Three or four OB/GYN offices told her they were not accepting new
Medicare patients. Finally, she persuaded a friend's doctor to take her.
But now the 75-year-old is afraid her new doctors will
drop her.
"You've got to be careful not to step on your
doctor's toes," Bowers said. "They don't want to mess" with Medicare because of
the low payments.
The Denver offices of Colorado
Patient Advocates, the Boulder County Medicare ombudsman's help line and the
private Colorado Gerontological Society are all fielding more calls from
Medicare beneficiaries unable to find doctors or pay for their prescriptions
Eileen Doherty, executive director of the gerontological
society, recently asked about 100 seniors attending a Medicare meeting in
suburban Littleton how many had a regular doctor.
"Only
one person raised their hand," she said. "When I asked how many have had trouble
finding a doctor, about half the hands went up, and when I asked how many had to
travel farther to get medical care, almost all the hands went up."
Some advocates say the problem seems to have stabilized
after their groups surveyed doctors' offices and distributed lists of physicians
still accepting Medicare patients.
Sometimes, however,
knowing how to navigate the system doesn't help.
Dorothy Rupert represented Boulder in the state Legislature for 14
years, working most of that time to make health care more available to
Colorado's poor. She knew the state's health-care system inside out and grew
concerned when new residents of The Academy retirement community told her how
hard it was to find a doctor.
But it wasn't until last
year, on her last day as the term-limited Democratic leader of the state Senate,
that she experienced firsthand the worsening Medicare doctor shortage.
Her husband, then 79, suffered a severe stroke and, after
the frantic 911 call, the emergency room and the intensive care unit, she began
trying to reach his physician of more than 20 years.
After days of repeated calls, the doctor's office manager "finally
called to say he wasn't Dick's doctor anymore," recalled Rupert, still an
activist at 76. "It was so hard to understand."
After a
months-long search -- aided by a private attorney -- for a Medicare-accepting
physician and a nursing home she could afford, Rupert finally moved her husband
to a facility near their son in Louisiana, where health care costs less and more
doctors accept Medicare.
"It wasn't that people [in
Colorado] weren't trying to help," Rupert said, "but if the access isn't there,
it doesn't matter."
Access often isn't there. According
to recent surveys, only 4 primary-care physicians in 10 accept new Medicare
patients in Colorado. In Colorado Springs -- where a former judge, military
retirees and leaders of prominent Christian ministries are among those unable to
find doctors -- the rate is closer to 1 in 10.
Increasing numbers of retirees are simply doing without a physician
until they get sick. Hospital emergency departments are serving as de facto
examination rooms for seniors, and many of the patients who arrive at the
Penrose-St. Francis Senior Health Center have gone without health care for a
while.
"Some patients have serious problems by the time
we see them," said Dr. Raymond Wahl, who came out of retirement to serve as the
part-time medical director of the Medicare-only clinic. "We get a lot of
referrals from doctors" no longer taking Medicare patients, he said. "It's a
desperate situation."
Opened in November 2000 as a
mission of the nonprofit Penrose Hospital and the private Penrose-St. Francis
Foundation, the clinic now has about 1,300 patients. They are seen by one of
three full-time nurse practitioners, who come cheaper than doctors. Wahl and
another physician work part time to handle consultations and various
administrative tasks.
Although the patients, by all
accounts, love the clinic, it is unclear how long it will continue to
operate.
About 90 miles away, the not-for-profit
Boulder Community Hospital has adopted a three-pronged approach to the Medicare
physician shortage. The hospital requires all of its 30 staff physicians to
continue accepting Medicare patients. It works with local physician groups to
recruit Medicare doctors to Boulder by subsidizing their relocation costs and
salaries. And finally, the hospital and the Boulder Medical Center, a large
physician group, opened a Medicare-only clinic on Sept. 1.
Peters and his colleagues now believe it's Congress' turn to act.
"I don't know if [Congress] can afford not to" increase
Medicare payments to doctors, he said. "In the long run, a fee increase will
cost less" than having Medicare patients resort to emergency rooms for their
health care.
For many physicians, the math is fairly
simple. In Colorado, private insurers reimburse doctors at rates often 25% above
what Medicare pays for the same services. Faced with that, individual physicians
and group practices have made a business decision that no more than some fixed
percentage of their patients can be on Medicare. Many are at their own ceiling,
unwilling to take any more Medicare patients.
Of
course, money is not the only reason doctors are dropping Medicare patients,
physicians say. Paperwork hassles, complex billing codes and a "paranoia" about
being accused of "fraud and abuse" also play roles.
In
the end, however, "it's really the cost of medical care that creates the
[access] problem," said Dr. David Downs, president of the Denver Medical
Society. "We love our Medicare patients, but there comes a point financially
where you can't afford to see them any more," said Dr. Ripley R. Hollister,
president of the El Paso County Medical Society in Colorado Springs.
In Washington, where the government has returned to
deficit spending and lawmakers weigh billions of dollars in competing demands
and services, the outlook remains murky for Medicare physicians and patients.
Ten-year cost estimates for a Medicare
prescription drug benefit range from $350 billion to $800 billion. The House
has passed and the Senate is considering a bill to restore about $11 billion in
cuts from doctors' Medicare reimbursements over 10 years, as well as to provide
additional Medicare payments for hospitals, nursing homes and HMOs.
The Bush administration has said the prescription drug
plans and the proposed Medicare fee increases would cost too much.
"Obviously," Lazarus conceded, "it's a matter of money.
But the government has made a commitment to take care of the elderly, so they
need to do it." If lawmakers learn of the serious access problems resulting from
Medicare fee cuts and still fail to do anything about it, he said, "they've
broken their covenant."
GRAPHIC: PHOTO: FAR FROM
COLORADO: A family photo shows Dorothy Rupert visiting her husband, Dick, in
Louisiana. PHOTOGRAPHER: Ellen Jaskol Rocky Mountain News PHOTO: PAINFUL
DECISION: Dorothy Rupert, a former Colorado legislator, saw the problem with
Medicare firsthand after her husband suffered a stroke. She had to move him to
Louisiana. PHOTOGRAPHER: Ellen Jaskol Rocky Mountain News PHOTO: 'CLOSE TO A
CRISIS': "Seniors are going without care, and patients are getting sicker," says
Jim Peters, vice president of Boulder Community Hospital. PHOTOGRAPHER: Ellen
Jaskol Rocky Mountain News
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