Fewer Primary Care Physicians Take Medicare Patients

By DIANE LEVICK
http://www.courant.com

When 65-year-old Anne-Marie Russo of Wethersfield went looking for a new internist late last month, she didn’t expect to end up so frustrated, after attempts failed with seven physicians.

“This is a real nightmare,” said Russo, a retired business manager at A.I. Prince Technical High School in Hartford who’s now on Medicare.

It can be difficult for people on Medicare to find a new primary care physician, and it will soon get even harder, doctors say.

Finding a new doctor can sometimes be tough for consumers under 65, too, as some overloaded primary care doctors aren’t taking any new patients. An increasing number of primary care doctors in Connecticut and around the nation aren’t accepting new patients who are on Medicare.

Though not a crisis yet, it’s a kind of “perfect storm” in health care. Doctors have complained for years that the federal Medicare program’s reimbursements to them are too low, and deep cuts in pay are coming in July unless Congress takes action.

In addition, as long reported, far fewer medical students are choosing to enter primary care, opting instead for specialties. At the same time, a post-Korean War generation of physicians is retiring. And the U.S. population is aging, with millions of baby boomers rolling into Medicare in the coming years.

“You’re on the edge of a huge national and local problem,” said Dr. Kent Stahl, chief executive and medical director of the Hartford Medical Group, which has more than 30 primary care physicians in multiple Hartford-area offices. “Certainly, in this community there is greater demand for primary care services than there is capacity.”

Nationally, 17 percent of Medicare-age consumers last year had a “big problem” finding a new primary care doctor and another 12 percent had a “small problem,” according to a survey sponsored by the Medicare Payment Advisory Commission. That compares with 13 percent and 12 percent, respectively, in 2005.

Finding a specialist wasn’t as hard. Nine percent had a big problem and 6 percent had a small problem last year, the survey showed.

Russo is looking for a new primary care doctor because she doesn’t want to drive to Southington anymore to see her old one, and she wants a physician who has privileges at Hartford Hospital. She wants to switch to a female doctor because she has been treated by female physicians and found she’s more comfortable with them.

Several of the doctors Russo inquired about practice in the Hartford Medical Group’s Wethersfield office. She says she was told they weren’t currently taking new patients, and to try back in May. On a second call to the office, after mentioning for the first time that she’s on Medicare, she was told the doctors there wouldn’t take new Medicare patients after May 1.

Stahl said each doctor in the Hartford Medical Group makes a decision on whether, and how, to limit his or her practice. More than half aren’t taking new patients of any age, while others could take a few more patients, and some are closed to new Medicare patients, he said.

One reason is that physicians want to maintain a “comfortable mix” of patients to make their practices more enjoyable, Stahl said. But the economics, he said, are hitting home, too.

Stahl said he finds that Medicare tends to pay 25 to 45 percent less than what commercial health insurers would pay for the same services, and patients of Medicare age tend to have more health problems and need more services than those under 65.

“So it’s more work for less money,” he said.

So far, there are no widespread reports of doctors no longer serving their existing Medicare patients.

However, the difficulty Medicare beneficiaries have finding new primary care physicians “is a very serious problem and it’s only going to get worse,” said Dr. Ardis Dee Hoven, an internist and member of the American Medical Association‘s board of trustees.

A 10.6 percent cut in Medicare reimbursements to doctors is looming July 1 unless Congress acts, and legislation has been proposed to deal with it. The figure is an accumulation of reductions under Medicare’s arcane formula that Congress has postponed each year.

If the cut takes effect, 60 percent of doctors plan to limit the number of new Medicare patients they treat, Hoven warned, citing an AMA survey.

The same national survey said about 40 percent of physicians planned to react to such a cut by limiting the number of existing Medicare patients they treat. More than half surveyed said they’d need to cut staff, and 14 percent of the doctors would quit patient care altogether.

Medicare’s payment formula is “flawed” and needs to recognize that doctors’ practice costs have increased, said Matthew C. Katz, executive director of the Connecticut State Medical Society.

A 10.6 percent Medicare reimbursement reduction in July and an additional 5 percent cut in 2009 would cost Connecticut doctors $190 million from July through the end of next year, the AMA said.

The Connecticut society has no data yet on how many doctors in the state aren’t taking new Medicare patients, but Katz said the situation is “significantly worse” than a few years ago.

Also, some physicians who had “accepted Medicare assignment” — accepted the program’s approved amounts as full payment for services — are no longer doing so, Katz said. Doctors who don’t accept assignment are allowed to charge up to 15 percent more than the Medicare-approved amounts. That means a larger share of the cost is shifted to senior citizens in the traditional Medicare program, or to their private supplemental insurance if they have a policy that covers the additional charges.

Many senior citizens are now in Medicare Advantage health plans, run by commercial insurers that are reimbursed by the government. Katz said he’s heard of some doctors dropping out of some of those plans.

In addition, the AMA says, Connecticut has an aging population of doctors — 43 percent of them are over 50. That’s an age at which many physicians start shrinking their practices in some way, Katz said.

But the picture isn’t totally bleak. Many Connecticut doctors are still accepting new patients, whether on Medicare or not. ProHealth Physicians Inc., which has 168 primary care physicians at 75 sites, says a few aren’t taking new patients of any age but most are open.

Russo, who has private insurance to supplement Medicare, says she’ll keep on looking for a new internist but is still taken aback by the turndowns.

“I just never had a problem with insurance, ever,” she said, “so this is mind-boggling to me.”

Contact Diane Levick at dlevick@courant.com.

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