Medicare problems could hurt seniors

Rick Cooper

Many patients don’t realize that Washington state is on the brink of a health care crisis. Patients are struggling to get the coverage and care they need. Physicians are being forced to go out of business or turn away patients. Why is this happening?

Many physicians are leaving or closing their doors, in part because state and federally funded programs, like Medicare, now pay physicians well below the actual cost of care. The government pays physicians who treat Medicare patients 20 to 30 percent less than 10 years ago. Reimbursement will decrease by another 5.5 percent for 2002. This reimbursement rate doesn’t come close to covering the real cost of the care provided.

Each time a physician leaves, about 2,000 patients must find a new caregiver. Remaining doctors are overloaded and can’t accept new patients. Patients are struggling to find physicians willing to accept new patients.

Medicare patients who cannot get care from a regular provider are seeking alternatives and resorting to services in hospital emergency rooms, which are costly. Higher cost emergency room care, that could be handled more routinely, drives up premiums for those patients who are insured through non-government funded programs. These patients carry an increasing burden.

Besides funding less than the actual cost of care, Medicare reimbursement levels also vary dramatically by geographic area. Snohomish County is below many other parts of the country. For example, Medicare reimburses $707 for a gallbladder operation in Everett; in Seattle they reimburse $753, and yet reimbursement for that same operation in Metro Boston is $843.

Another significant problem is the amount of paperwork that must be completed when a Medicare patient is treated. Any medical procedure that is eligible for Medicare reimbursement comes with a voluminous paperwork requirement. The American Medical Association estimates one hour of administrative paperwork for every one to four hours of patient care. This leaves less time for physicians to actually treat patients, further complicating access to care and driving its cost upward.

The paperwork burden, combined with low reimbursement levels, means that many doctors literally cannot afford to accept Medicare patients. This puts doctors in the awkward position of either putting limits on the number of Medicare patients they can serve, or actually turning away Medicare patients altogether. Those that do not, soon find themselves in a downward financial spiral.

For seniors, this means that access to medical care is a significant problem, and it’s likely to get worse. With the aging baby boomers, we’re surely headed for a crisis if we don’t take action. Actual rationing of health care for seniors is a distinct possibility.

At The Everett Clinic, we are fortunate that we have not had to turn away or ration care for Medicare patients, yet. But quick action must be taken to reverse this disturbing trend.

What are the answers?

While there are no easy answers, change will only happen if the public is informed and patients demand solutions from our policymakers.

What can you do?

Ask questions and educate yourself and others about this critical issue. Get involved. Write to your legislators, both state and federal, and let them know you are concerned and want change. Some key areas of concern:

n Increase the level of Medicare reimbursement to the actual cost of service, or at the very least, far closer to the actual cost of care.

n Provide equity in geographic payments for Medicare.

n Streamline the amount of paperwork required for Medicare covered procedures.

For information on how to contact your state or federal legislators, go to everettclinic.com and click on "legislative advocacy." You will find a sample letter and instructions on how to email or write your elected officials.

Rick Cooper is CEO of the Everett Clinic.

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