Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, April 11, 1994 TAG: 9404110044
SECTION: NATIONAL/INTERNATIONAL PAGE: A-4 EDITION: METRO
SOURCE: Associated Press
DATELINE: WASHINGTON LENGTH: Medium
"When you turn 65, you become a second-class citizen," complained Bea Zirk. "You're at the mercy of doctors who won't accept you as a Medicare patient."
A new 491-page report to Congress says Medicare now pays physicians just 59 percent as much as private insurers pay. Five years ago, Medicare paid 68 percent as much.
The widening gap has stirred fears among health officials and advocates for the elderly that more Medicare patients could find themselves in the same boat as the Zirks.
Poor people on Medicaid long have encountered obstacles in finding private doctors to treat them; Medicaid pays just 47 percent as much as private insurance.
But Medicare, which covers virtually all of America's elderly, has never had that stigma.
The Physician Payment Review Commission, a 13-member panel that advises Congress on Medicare and health reform, said surveys of patients and physicians indicate that the problem so far is not widespread.
Relatively few seniors - one in 4,000 - complain to members of Congress about finding a doctor, and 95 percent of physicians taking any new patients accept those on Medicare.
Medicare patients with "an ongoing physician relationship appear to be the least at risk for loss of access," the commission said. "Once that relationship is broken, however . . . relatively lower-paying Medicare patients may have difficulty finding their way onto the schedules of already fully booked primary care physicians."
That's "just human nature," said Dr. Pepi Granat, a family practitioner in South Miami, Fla. "You can only see 25 patients a day. . . . If two people walk in the office and one's Medicare and one isn't, who are you going to take?"
Granat turns no one away from her solo practice, but doubts she could pay the rent if all her patients were on Medicare instead of just a third. The elderly often have multiple, chronic health problems.
"The Medicare patients take twice as long," said Granat. With an 85-year-old woman who came in unable to hear and without her glasses, "I had to repeat everything 10 times. I had to write out the instructions. How long do you think that stuff takes?"
Most doctors won't stop taking Medicare patients because "it's against the humane ethic . . . [and] even at the lower rate, we need those patients," said Granat.
The government in recent years boosted Medicare payments to general and family practitioners while cutting back on surgeons, cardiologists and other specialists. But the volume of services that doctors perform on Medicare patients grew by 50 percent from 1986 to 1993.
The Clinton administration, under its health reforms, would tighten the standards and reduce Medicare rates to just 43 percent to 52 percent of private rates by 2000, the commission estimated.
Without those reforms, Medicare would pay somewhere between 54 percent and 61 percent of private rates by then.
Bruce Vladeck, the head of the Health Care Financing Administration, which runs Medicare, said he is concerned about preserving "first-class access to service" for the elderly.
But "it's sort of insane for a public program to try to continually play catch-up with an uncontrolled private sector," said Vladeck.
He's also skeptical about doctors' claims they lose money treating Medicare patients.
"Docs will tell you they're losing money if they treat somebody for $20 and they think somebody else would pay them $25 for the same thing. But they're still getting $20," said Vladeck.
Paul Ginsburg, executive director of the Physician Payment Review Commission, said treating Medicare patients is not necessarily a money-losing proposition.
More than half the revenues that physicians pull into their practice winds up in their net income, said Ginsburg.
"The fixed costs are already paid," he said. "What are the marginal costs of an additional patient? Some additional time for the physician, but no more rent, no more utilities, perhaps no more staff expenses. . . . There could still be significant additions to the physician's income."
Most Medicare patients are middle class with a longstanding relationship with their doctor, said Ginsburg. "The physician is not going to kick them out just because the Medicare payment rates went down a little bit."
by CNB