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The Doctor Is Out

By Chris L. Jenkins
Washington Post Staff Writer
Tuesday, December 9, 2008

Glenda Fried had heard the stories but never quite believed them. While she had had no problem getting her primary care physician in suburban Chicago to accept her Medicare health insurance, friends across the country were telling her about the devil of a time they were having. They talked of having to make at least 15 calls before finding a new primary care physician who participated in the taxpayer-funded medical insurance program largely for those 65 and older. Fried, 68, chalked it up to bad luck.

But when the retired school administrator moved to Chantilly this year to be closer to her son and his family, she realized there was some truth to the stories: Phone call after phone call was met with apologetic office mangers saying that Dr. X wasn't taking any new Medicare patients or Dr. Y wasn't taking any type of insurance at all.

"I must have made 12 calls before I could nail it down," she said recently. It took her a few weeks, she said, to find a physician she felt comfortable with. "One or two weren't taking new patients at all, but the vast majority were just not taking Medicare. And they were taking other forms of insurance."

Fried's experience is a growing concern among policymakers and health-care experts who envision a shortage of family medicine doctors and geriatricians to care for an aging population.

Health-care experts and advocates for the region's elderly say the problem is partly a reflection of how worried physicians are about changes in reimbursement rates from the federal government. Some physicians say they are afraid of accepting new Medicare patients and discovering later that the amount they receive for treating them will be decreased. Exacerbating those worries are concerns about the slow pace of reimbursement and the layers of paperwork it requires.

The nation's 44 million Medicare patients, on the other hand, tend to be satisfied with their treatment and are able to access care without delay once they have a physician, according to national surveys.

While statistics are not available for the D.C. region, the Medicare Payment Advisory Commission reported last week that nearly 30 percent of the 2.6 million Medicare beneficiaries seeking a new primary care physician between September 2007 and October 2008 had trouble finding one, up from 25 percent in 2005. To encourage primary care doctors to accept new Medicare patients, the commission recommended to Congress in June that it increase payments to those practitioners by redistributing payments for specialized care.

The group also found that Medicare patients seeking new primary care physicians were more likely to experience trouble finding one than those looking for specialists.

Zerline Chambers-Kersey, a primary care physician in Dumfries, said she decided last month stop taking new Medicare patients at her 9,000-patient practice. She said the delay in reimbursement and the constant worry that her rates might be cut were enough for her to also tell those currently on Medicare she would no longer see them after the end of the year. Even though she has only 150 Medicare patients now, she anticipated that this number would have grown to 600 next year because of the aging of her patients.

"It's just too frustrating," said Chambers-Kersey, who's been in practice by herself for 13 of her 25 years of experience.

"It's a business decision . . . a painful one, and in the middle my patients are the ones who feel it the most." She said she is helping her affected patients find new doctors who take Medicare as she informs them of her decision.

In the National Report Card on the State of Emergency Medicine released today, the American College of Emergency Physicians says that for every 100 Medicare beneficiaries, the District has 11.3 physicians who accept this coverage, a higher rate than any of the states.

Local advocates for the elderly say the problem of finding such physicians seems to be felt most acutely in Virginia, which has just 2.5 physicians accepting Medicare per 100 beneficiaries, according to ACEP. (The rate in Maryland is four per 100, a little better than the national average of 3.2 per 100.)

Those who counsel seniors in Northern Virginia said that they have received dozens of phone calls over the past several months from seniors looking for help joining a Medicare family practice.

"It's not the folks who already have a doctor and transition into Medicare that are having the problem," said Howard Houghton, program manager for the Fairfax chapter of the Virginia Insurance Counseling and Assistance Program, a service run by the state's local Area Agency on Aging centers. "It's those who are switching doctors or are moving to this area."

Much of the pressure on doctors has come from threatened reductions in fees under the formula that sets Medicare spending. Doctors were slated to receive a 10.1 percent cut in the reimbursement rate this past January and a 10.6 percent cut in July. Congress blocked the reductions both times: Doctors actually got a 1.1 percent increase. But the periodic specter of reductions is enough to leave some feeling wary.

Joseph Antos, a senior fellow for health-care and retirement policy at the American Enterprise Institute, said that it was largely the political debate over the Medicare rate cuts that worried doctors, but that he doubted Congress would ever follow through on such drastic measures.

Lobbyists for doctors and the elderly argued that cutting reimbursement rates would prompt doctors to drop out of the program: In a national survey taken this spring, the American Medical Association suggested that 60 percent of physicians would have stopped taking new Medicare patients if the July cuts had gone through.

But that hasn't eliminated the possibility of cuts in the future.

"The lack of predictability with these Medicare rates is very worrisome to many doctors," said Nancy Nielsen, president of the American Medical Association.

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