Doctors accepting Medicare are hard to find

By Chris Cobb

John Pantermuehl just needed a doctor.

He’s a senior on Medicare.

And like many in others in America, he’s learning that it can be tough to reap the benefits of a government program he’s been literally buying into for most of his life.

“It can be a very frustrating experience for people desperately searching for doctors,� he said. “A huge amount of people depend upon doctors accepting them as Medicare patients and not screening them by asking ‘what’s your insurance?’�

At doctor’s offices in Comal County, saying “I have Medicare� doesn’t get you past the waiting room, and patients like Pantermuehl are being turned away every day.

Pantermuehl relied on family friends to help him find a local general practitioner after unsuccessfully visiting several on his own.

Only after being rejected a few times did he realize the seriousness of the economic quandary facing the sick and those paid to heal them.

“I think what we’re seeing is the tip of the iceberg,� said Dr. Josie Williams, President of the Texas Medical Association. “Physicians are no longer willing to carry the Medicare system on their backs.�

Fewer and fewer practices are willing to accept new Medicare patients, whose only form of payment offers significantly less compensation for doctors than private insurance carriers.

“Unless this flawed system is fixed soon, more and more doctors in Texas and across the nation will be forced to shut their doors to Medicare beneficiaries,� said U.S. Sen. John Cornyn. “As a result, many seniors will have trouble accessing the specialized care and services they need, and health care costs will continue to rise.�

• What’s the problem?

Health officials say the problem is two-fold: Medicare reimbursement is cheap, and there’s a paucity of physicians offering general practice care all over the country, especially in New Braunfels.

“The government’s approach to controlling costs is just cutting down on what they pay,� said CHRISTUS Santa Rosa Health Care Regional CEO Don Beeler. “It’s gets to the point where physicians are forced to limit the number of Medicare patients they take. It’s especially a problem if you have a shortage of physicians in certain areas, and we certainly have a shortage in New Braunfels.�

Officials said graduating medical school students are increasingly avoiding becoming primary care physicians, and internal medicine and family practitioners — areas of medicine that more and more are becoming very hard work for little reward.

“There’s no one going into primary care,� Williams said. “They don’t think they can afford it. They get paid on the low end of the pay scale in spite of the fact that they take care of the sickest patients.�

With fewer doctors in the area capable of offering basic general care, there are naturally less options available for anyone seeking it.

To try and combat what is a state-wide shortage, the Texas Medical Board speeds up the licensing process for doctors who pledge to treat Medicare patients, according to board spokesperson Jill Wiggins.

In addition, CHRISTUS is trying to work with local practices to bring quality caregivers to the New Braunfels area.

“If somebody wants to recruit somebody to join their practice, then we’re more than willing to help,� Beeler said.

The health care provider offers loans to doctors who might be interested in moving to the area to practice medicine. Those loans are not required to be paid back if the doctor stays here for an extended period of time and treats every patient who comes through the door.

And while having more doctors in town would help the situation, it doesn’t change the economic reality that treating Medicare patients is just not cost-effective for any physician.

“Doctors don’t want to take more Medicare patients,� said Dr. Dorothy Overman, who practices in New Braunfels. “If someone comes in with insurance, they’ll get paid more for the same visit.�

Overman is part of a team of physicians at Hill Country Medical Associates, who like many clinics, can’t welcome new Medicare patients.

“If you want to keep your doors open and make the same salary you were making before, you really can’t afford to take on new Medicare patients.�

• What does Medicare pay?

Medicare is on a fixed-budget system that includes a sustainable growth rate, a formula the Centers for Medicare and Medicaid use to try and figure out how much to pay physicians. The formula is based on fixed rates — the gross domestic product per capita — rather than the actual costs of practicing medicine, according to the American Medical Association.

Whenever Medicare costs go over that fixed budget — which health officials say is almost always — the SGR seeks to cut reimbursement rates to doctors to make it back under budget.

Williams and others are hoping the government can find a new system that more accurately reflects the cost of doing business so doctors aren’t forced to shut their doors on new Medicare patients.

“The long-term solution has got to be a permanent fix to the SGR,� Williams said. “It’s flawed. Congress knows it’s flawed. But they’ve kicked the can down the road for so many years that now the large bill it will take to fix this thing — they politically can’t handle it.

My biggest fear is that they won’t have the political will to solve this crisis,� she added. “I don’t think they recognize how close to imploding the system really is.�

• Political solutions?

Voting to stall cuts to Medicare reimbursement rates is almost an annual tradition in Washington.

The latest such vote came in July.

A number of physicians and some in the federal legislature have said they’ve grown tired of these “band-aid� measures and would like to see a more permanent fix to the growing Medicare problem.

Cornyn, along with fellow Texas Sen. Kay Bailey Hutchison, voted for the latest stall in reimbursment cuts, but said he would like to see the problem actually get solved.

“Earlier this year, I introduced the Ensuring the Future Physician Workforce Act of 2008, currently the only long-term solution to this problem that will keep resurfacing every 18 months if a long-term fix is not put in place,� he said. “My bill would get rid of the unsuccessful spending cap, focus on improving health care delivery and lowering costs, and restore more peace of mind to beneficiaries and providers.�

To date, a vote has not been held on the bill, which continued to languish while the stall in cuts passed in July.

According to Williams, the temporary measures do little to solve the problem. Even though cuts haven’t gone into effect, she said the cost of practicing has gone up by 20 percent in the last 10 years.

“Our country’s Medicare beneficiaries need more than a band-aid,� Cornyn said. “They need lasting, quality care that they can depend on. I will continue to work to bring both sides of the aisle together to reach a long-term solution that benefits patients, doctors and our entire health care system.�

• Where to go?

There a few local clinics that will accept all patients, including two CHRISTUS Family Health Clinics, one on County Line Road and another on San Antonio Street.

Outside of those, there aren’t many options for Medicare seniors in New Braunfels and Comal County. Many wind up like Pantermuehl, bouncing from clinic to clinic in frustration.

“It’s almost a hostile medical environment for people on Medicare,� he said. “This is the system that the United States has bought into. Until it changes, we need to respect the fact that we’re all we’re going to turn 65 some day; we’re all going to be on Medicare, and we’re going to have to find a doctor.�

But changing the system to ensure all Medicare patients get quality access is something more easily said than done, and likely would take a seismic action on the legislative level, according to Beeler.

“We don’t have a systematic approach to financing health care in this country. That’s plain and simple,� he said. “We’ve got to come up with a different model and I think society has got to bear some of that expense. Quite frankly, it does now anyway.�

“If we can figure out how to put somebody on the moon, we ought to be able to provide universal access with some level of coverage.�

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