August 2007
Why doctors aren't accepting new Medicare patients
When Ardelle Hubbert moved to Reno from Arizona in 2000, she found a primary-care physician easily enough. But in 2005, when her doctor left her practice, it was a different story.
First she tried calling the six physicians to whom her departing physician had referred her. None would take on a new Medicare patient, not even one like Mrs. Hubbert who had Medicare and a supplemental insurance plan. So she began calling doctors out of the phone book.
“I tried about 17 or 19 before I stopped counting.” says Mrs. Hubbert, now 82. “It will be two years in September since I've seen a regular physician.”
If you are on Medicare and new to this state or if, like Mrs. Hubbert, you've lost your regular physician, you almost certainly can relate to her story. At the Sanford Center for Aging, we get calls every week from elders or their sons or daughters looking for doctors who will accept new Medicare patients.
They are hard to find. We've heard of people having success with certain clinics and hospitals, but primary- care doctor's offices are another matter. One source worth consulting for leads is the Washoe County Medical Society (825-0278) or the Nevada State Medical Association (702-798-6711).
What's the problem? Essentially it comes down to economics. Physicians prefer to limit the number of Medicare patients they see because they can make more money seeing patients who have private insurance plans or pay cash.
Here's an illustration: Medicare determines what an hour of a physician's time is worth in a given market. Say that in northern Nevada they set the rate at $100. Medicare may further stipulate that a certain type of exam should take 15 minutes. So for that exam, Medicare would say that the doctor is owed a quarter of the $100 hourly rate or $25. Medicare pays 80 percent of costs, so the government program pays the doctor $20, leaving the patient responsible for the other $5.
The problem is nongovernmental insurers often reimburse doctors at a higher rate. If that rate were $120 an hour, the same doctor doing that same 15-minute exam could get onequarter of $120 or $30 from the privately insured patient. That $10 difference might not sound like much, but over the course of weeks and months, it adds up. For physicians with higher overhead - like additional staff, new equipment, or an office in a high-rent district - it could spell the difference between profit and loss. But what about Medicare supplemental plans - don't they make Medicare patients more attractive to physicians?
They don't, and here's why: Those plans only make up the difference between what Medicare allows and what Medicare says the patient should pay, which is that other 20 percent of allowable costs. In the hypothetical above, that's the $5 difference between Medicare's $25 quarter-hour rate and the $20 Medicare actually pays the doctor. The supplemental plan pays the $5 for the patient, but it doesn't elevate the doctor's take-home to the $30 or more he or she would prefer. Also, as one doctor told me, the additional paperwork involved in filing supplemental insurance claims can add 30 to 40 percent to the practice's cost of doing business.
Another reason most doctors try to limit their numbers of Medicare patients is that Medicare patients are, by definition, older. And, generally speaking, the older a patient is, the longer he or she takes to treat. The typical 65-year-old is dealing with at least two chronic conditions like arthritis or heart disease. Insurance plans don't always take that extra time demand into account. So you can understand why physicians don't relish seeing a waiting room full of nothing but older people. It's also a reason why geriatric specialists are a rare breed.
Note that this problem applies mainly to doctor's office visits. If you have to go to the hospital for an acute illness - a broken hip, a heart attack - Medicare will take care of it. The hospital will not tell you it no longer accepts Medicare inpatients. Also, the low Medicare reimbursement rates are primarily a problem for primarycare physicians. Specialists are better compensated for procedures and when they act as consultants. Many elders reading about this scarcity of primarycare physicians accepting new Medicare patients will think it's no concern to them. They've been seeing their doctor for years, and the doctor still accepts Medicare. But what if your doctor retires or moves?
So what's the solution? In terms of Medicare, you could write to your federal representatives and encourage them to insist Medicare raise its reimbursement rates for primary care, or that Medicare at least keep the rates level. Come January, the rates are actually going to be lowered by 10 percent. Given that fact, finding a doctor accepting new Medicare patients figures to become even more difficult. To help in the search, the Sanford Center for Aging is hoping to survey physicians later this year and find out which (if any) are accepting new patients. We also want to create a directory of physicians certified in geriatrics. Studies show that fewer than 3 percent of medical professionals nationally are certified in geriatrics. I suspect the rate is even lower in Nevada, which suffers from chronic shortages of doctors, nurses and other health-care professionals.
As this information becomes available, we'll post it at the Sanford center's website, www.unr.edu/sanford. We hope the findings will draw more attention to this problem and spur action. The sooner the better.
Lawrence J. Weiss, Ph.D., is director of the University of Nevada, Reno Sanford Center for Aging and an adjunct associate professor of medicine. He welcomes your comments on this column. Write to him at weisslj@unr.edu or c/o Sanford Center for Aging, Mail Stop 146, Reno, NV 89557-0146.