03/22/10 — Potential Medicare cutbacks limit care

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Potential Medicare cutbacks limit care

By Laura Collins
Published in News on March 22, 2010 1:46 PM

When Alton Glenn Smith Jr. went to Immediate Care in early March, he was not expecting the reaction he received.

Smith, 69, was suffering from bronchitis. To make matters worse, he had two herniated disks that caused him pain when he coughed.

"When she found out I have Medicare as primary coverage, she said, 'I'm sorry, we can't see you,'" he said.

March 1 and part of March 2, Immediate Care was not taking patients insured by Medicare. According to the information they gave to Smith, it was due to the 21 percent cut in Medicare reimbursement that was expected to go into effect because Congress was slow on voting to extend the current coverage for another month. Eventually Congress passed a one-month extension that would delay the proposed 21 percent cut, but that extension lasts only until April.

"I'm 69, I've worked for 50 years and I've paid my Social Security and Medicare premiums," he said. "And when I go to a doctor, to be told because I'm on Medicare I can't get service, this is just not right."

Smith said he was not only caught off-guard, but even more so, he was disappointed in the whole process. Area health care providers are concerned this will all happen again come April 1.

"Unfortunately doctors don't have a lot of power (in determining Medicare reimbursement)," Immediate Care office administrator Jacqueline Harris said. "We will accept Medicare patients until it gets to the point where it's hurting our business, then we can't afford to do that."

Ms. Harris said Immediate Care is trying to get as much information together as possible. She said the practice has three options should the 21 percent cuts go into effect -- continuing to participate; non-participating, which means still seeing Medicare patients but the clinic wouldn't be limited to Medicare's fee schedule (meaning that the clinic would have the option of charging more for some services and expect the individual or a co-insurance to cover the difference); or to opt out completely and not see any Medicare patients.

"We'll have to make a decision as a group," Ms. Harris said. "Every year (Congress) doesn't do something, the cuts get higher."

She estimates that if the 21 percent cuts go into effect, the reimbursement for an average office visit would be about $40. Twenty percent of the clinic's patients are on Medicare and she said since many of them are elderly, they often have multiple health problems, which a $40 reimbursement wouldn't cover.

"We hope this all turns out for everyone's good," she said.

At Southeastern Medical Oncology Center, administrator Bo Gamble said the center is unwilling to have patients take the fall for a "flawed" Medicare system.

"We said we were going to opt to see patients anyway and hopefully (Congress) will fix it," he said. "I think our representatives are no longer effective and politics are getting in the way of taking care of people and it's just really, really sad."

At Wayne Memorial Hospital, Becky Craig, vice president of finance, said the cuts won't affect the hospital as much as the individual doctors. Since the doctors aren't employed by the hospital, the 21 percent cut in their reimbursement will affect the doctor directly.

"It's not a direct impact on us, but anything that impacts our physicians potentially would have a negative impact on the whole community," she said. "If we have doctors that have decided they can't make it with that kind of cut, that hurts everyone."