Some local doctors, once again faced with a large cut in what the government pays them for treating Medicare patients, are telling senior patients they must switch by year's end to better-paying private Medicare Advantage plans.
Some local doctors, once again faced with a large cut in what the government pays them for treating Medicare patients, are telling senior patients they must switch by year’s end to better-paying private Medicare Advantage plans.
Paul Williams, 72, was one of about 6,000 patients who recently received a letter from Highline Medical Group, a consortium of 35 doctors in eight clinics in the South Puget Sound area, telling them to switch plans by Jan. 1, when traditional Medicare reimbursements are set to shrink by 25 percent.
“It’s kind of scary when your doctor sends you a letter saying ‘I’m going to quit serving you,’ ” said Williams, a retired Boeing research engineer. “I prefer traditional Medicare and want to stay on it, but feel I am being forced off.”
In the letter, doctors told the patients: “We know this is a hassle and we apologize.”
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Williams and other patients are the collateral damage in a long-running skirmish between Congress and doctors. More than a decade ago, lawmakers passed a law tying Medicare payments to the economy’s growth rate, and when it slowed in 2002, trimmed the payments for the first time.
Since then it’s gone like this: Lawmakers threaten to cut Medicare payments and doctors threaten to stop taking Medicare patients. At the last minute, Congress suspends the payment cut, usually for a year but recently for several months. Each time, the size of the threatened cut grows.
This year, most of the cut is slated to take effect Wednesday, but Congress is expected this week to reset that deadline to Jan. 1. If lawmakers do nothing to prevent it, the full 25 percent payment cut will take effect then.
For doctors, particularly those who practice primary care, this is familiar turf. Many have long complained that reimbursements from traditional Medicare are too low, and many already have stopped taking new Medicare patients or limited the number, according to surveys done by the Washington State Medical Association.
Responding to an unscientific “snapshot” survey by the association in February, about 22 percent of the state’s doctors said they would take no new Medicare patients if the planned cut goes into effect.
Dr. Dean Martz, a Spokane neurosurgeon and president of the association, said doctors have been living with financial uncertainty for years as Congress wrestles with the Medicare formula.
“Typically, they walk us up to the cliff, then say, ‘We found some more money.’ ” This year, he said, Congress has taken doctors to the cliff for the third time.
For doctors and clinics, this brinkmanship is unnerving, Martz said. “You have employees you’re responsible for, and you have to be able to plan for the future … . It’s impossible with this sort of uncertainty.”
Some argue that doctors could and should become more efficient. AARP state advocacy Director Ingrid McDonald agrees that medicine must move from paying for “quantity” of care to paying for “quality and outcomes.”
“But in the interim,” she adds, “we cannot deny we will have a serious access problem if we cut doctors’ pay under Medicare by 25 percent. It would be ugly.”
Ugly was what Highline Medical Group’s administrator, Susan Purcell, was trying to avoid.
“We really want to see patients, but we’re having to ask them to get into something that will give us some kind of economic stability,” she said. “At some point, it’s very hard to continue business.”
Many other clinics have encouraged or required seniors to switch to Medicare Advantage plans, she said, “primarily due to the differential in payment.”
Tracy Corgiat, spokeswoman for the Polyclinic, a large Seattle multi-specialty group, said Medicare Advantage plans also allow more flexibility in caring for chronically ill patients.
Some of The Polyclinic’s 160 doctors still take patients on original Medicare, although most limit the number. If the cut goes through, The Polyclinic and other groups say they would have to stop accepting those patients.
For the doctors at Highline Medical Group, which is affiliated with Highline Medical Center, the financial situation is even more acute because they all practice primary-care medicine, unlike groups such as The Polyclinic that include specialists — typically better reimbursed by Medicare.
About 80 Highline patients become eligible for Medicare every month, Purcell said.
In the past, clinics have been able to compensate for low Medicare payments because most of their patients have private insurance that pays better, she said, but economic pressures have squeezed those payments, too. “This is a complex problem,” Purcell said of the payment system. “It’s very broken.”
To keep their doctors, Highline’s Medicare patients must pick one of six Advantage plans from three insurers — before Jan. 1. Many with original Medicare have a supplemental policy that helps pay their share of medical bills and they worry that once they cancel those supplemental plans they won’t be able to get them back.
With federal subsidies to Medicare Advantage slated to start decreasing in 2011, many patients also worry that they’ll pay more out-of-pocket.
In addition, the companies that run Advantage plans can close them as they see fit. And dozens of plans did close in Washington this year, leaving more than 40,500 seniors to find new coverage.
“We’re between a rock and a hard place,” said Theresa Duke, whose husband is on traditional Medicare and doesn’t want to lose his Highline doctor. Even if he switches to an Advantage plan now to keep his doctor, there’s no guarantee, she says, that Highline will accept Advantage plans down the road. “Now I’m worried.”
Williams, who attended one of a series of meetings Highline Medical Group is holding to help patients sort out their options, said he noted that the Medicare Advantage plans had lots of co-payments of various sizes.
“The co-pays are really weird,” he said, ranging from $5 to $50. “It got confusing.”
When he broke his wrist in August, Medicare covered the costs, with his supplemental, he said. If he’d been insured by the Advantage plan he’s considering, he would have had seven or eight co-payments, he calculated. “It adds up to some serious money!”
Williams, who’s been seeing Highline doctors for 20 years, said he understands their dilemma and doesn’t blame them for not wanting to lose money.
He and his wife will make the switch “just because I don’t trust Congress,” he says. “We’ll go with a Medicare Advantage plan and hope that a year from now, we’re not sorry.”