Linda Kelsch of Vienna was surprised to learn recently that her doctor's office had decided to accept no more Medicare patients. At 53, Kelsch is not close to Medicare age, but the decision by Vienna Family Medicine miffed her nonetheless. "I don't know the pros and cons of it," she said, but "I was just appalled."

The rule was adopted "purely for economic reasons," said James P. Jenkins, a physician with Vienna Family Medicine. "We're constantly reevaluating" which insurers to accept, he said, and "Medicare is far and away our worst payer." In fact, according to a letter distributed to the practice's patients, "the rates paid by Medicare have fallen so low that we cannot provide [the] quality care our patients deserve and still have a viable business." Ten to 15 percent of the group's patients use Medicare, Jenkins said.

Roberta Sorenson, executive director of the Medical Society of Northern Virginia, said it's increasingly common for physicians to wonder "how many Medicare patients they can take."

Last summer, the American Academy of Family Physicians reported that almost 22 percent of survey respondents said they were not accepting new Medicare patients; a year earlier, the number was 17 percent.

In September, the Center for Studying Health System Change reported that 71 percent of physicians accepted new Medicare patients in 2001, down from about 75 percent in 1997.

"No new Medicare patients" policies appear to be more of an inconvenience than a crisis. Robert M. Hayes of the nonprofit Medicare Rights Center said, "Rarely if ever are folks unable to find a good physician who will accept them as a new patient." In the District, Medicare patients "are probably not having significant problems finding doctors," agreed Suzanne Jackson, director of the Health Insurance Counseling Project at the George Washington University Law School, though "we have been getting some calls from people" having difficulty obtaining such care in affluent neighborhoods.

There's even evidence that, for at least some physicians, Medicare rates are competitive. Physicians Practice magazine reports this month that "the federal government is a surprisingly good payer for many practices, at least for office visits."

More than 300 practices told the magazine in a survey that private insurers typically paid them $81 to $90 for a new patient's routine visit last year, compared with a Medicare payment of $135. A more complex visit brought a doctor $101 to $110 from private plans, compared with $181 from Medicare.

"Practices that are considering closing to new Medicare patients," said Pamela Moore, senior editor of Physicians Practice, "should be very sure that other payers in their market will truly offer better pay."

-- Tom Graham

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