| 10/15/2006 |
| Medicare cuts squeezing doctors, seniors |
| By: Bob Zientara |
But he also has become a lobbyist, a witness who has testified before Congress, and an advocate for mid-Iowa senior citizens, many of whom depend on Medicare for the money needed to pay their doctor bills. The view ahead does not bode well, Kitchell said in a recent interview. Unless Congress acts, Iowa seniors face a 7.1 percent reduction in their Medicare Part B (doctor bill) reimbursements as of the first of the year. "If there is a halt to the cut," he said, "it will be a temporary fix, but I am really concerned about the long run. "And if nothing is done, we face a crisis."
Most other areas of the country face a cut of just more than 5 percent, based on a formula enacted by Congress in 1998, called the "sustainable growth rate." Since it went into operation, the sustainable growth rate has been acting as a brake on Medicare spending increases. But it's not applied evenly across the country. "We have what's known as a geographic penalty, which explains why (doctors in Iowa) get paid less (in Medicare Part B reimbursements) than Chicago, San Francisco and Boston," Kitchell said. The varied reimbursement rate is based in part on the cost of doing business in larger and more expensive urban areas. Iowa Medicare reimbursement rates are 20 percent less than Chicago, 25 percent less than Boston and 35 percent less than San Francisco. So what about the notion that doctors are well-compensated in the first place, and that Medicare cuts won't significantly hurt those six-figure incomes? "The average person says, 'boy those doctors make a lot,'" admitted Kitchell. But that's not the real issue. "It's that the average doctor works a lot harder here because of the number of patients." The challenge - finding doctors The real squeeze is going to come when the doctor's cost of doing business collides with the declining rate of Medicare reimbursement, Kitchell predicted. "Physicians' ... expenses rise an average of 3 percent per year," said Kitchell. "With a 40 percent (Medicare) cut in eight years, it will create two forces that could result in total disaster," he added. "And here's why it's a crisis in Iowa. We already have a shortage - Iowa has half as many doctors as Massachusetts, on a per capita basis. Any way you look at it, doctors in Iowa have to take care of twice as many patients. "When you add the fact we have the nation's 4th highest percentage of Medicare patients in the U.S., you can see the problem." The danger - doctor burnout The size of McFarland clinic - with 159 physicians on staff - and the attractiveness of Ames as a good place to live, eases the effects of patient overload here, to an extent. But Kitchell said clinics throughout the state are finding it harder to recruit and retain quality doctors, including nine key specialties: psychiatry, orthopedics, general surgery, urology, cardiac surgery, neurology, gastro-enterology and thoracic surgery. The result: a real danger that some doctors will simply refuse to see Medicare patients, he said. "It's not just in Iowa, but all over the U.S.," Kitchell said. "Soon, there will be people who call a doctor who will say, 'I can't afford to add any new Medicare patients.'" McFarland's professional staff now serves a total of 300,000 patients. About one-third is served by Medicare. Although statistics vary for individual doctors, the basic math shows each doctor serves nearly 1,900 patients. The average work load is high, and the strain is beginning to show. "We are recruiting 25 additional doctors," said Kitchell. "Some of the openings have been unoccupied six to seven years. "We will continue to see Medicare patients even with the cut - but I can't guarantee that all of us will, and I can't speak for the doctors in other communities who may say no and increase the number of patients here," he said. Bob Zientara can be reached at 232-2160, Ext. 487, or rzientara@amestrib.com. new financial assistance record set The financial picture for Medicare Part B (doctor bills) may not be good, but at Mary Greeley Medical Center in Ames, financial assistance for patients has never been better. Brian Dieter, vice president and chief financial officer, reported late last month that the Ames medical center provided a record amount of financial assistance during fiscal year 2006, a total of nearly $2.2 million dollars in financial assistance to more than 2,000 patients. It was a 22 percent increase over fiscal year 2005. "We have proactively developed a financial assistance program that ensures all who come to us for needed care receive it," Dieter said. Since 1999, the center has provided more than $11 million in financial assistance to patients who were unable to pay part or all of their hospital bills. Financial assistance is based on a sliding fee scale for those earning up to 250 percent of federally recognized poverty guidelines. Patients afflicted by a catastrophic health event may also be eligible for assistance based how much they owe and their income level. For more information, call 239-2119. - Bob Zientara, staff writer For low income adults, health care access is an issue By Bob Zientara Staff Writer Medicare patients may face fewer choices for their care, but at the Story County Human Services Department, sometimes the question is whether there is a choice. Earl Crow, income maintenance supervisor, and his workforce of 10 professionals serve a county population base of between 70,000 and 80,000. Each worker has a case load of about 400 individuals. There is a large list of eligibility criteria, and coverage depends on whether the patient is an infant, a child age 1 to 18 or an adult, family or individual income changes eligibility frequently. "Medicaid guidelines change all the time," Crow said. "Iowa's set of criteria will differ from most other states. Each plan depends on how the Legislature designs its formulas." One of the biggest recent changes: Medicaid will now serve only U.S. citizens. If a patient doesn't fit Medicaid's guidelines, the office often helps find another provider in the county - often a nonprofit organization. Medicaid and Medicare sometimes interact with one another. Crow said that elderly and disabled Story County patients can be eligible for both plans. Access to health care does not seem to be an issue so far, but Crow qualified that. "Our job is to put the coverage in place and refer each person who's qualified to a provider," he said. "That said, I can't say we're running into providers who are refusing to see patients. "As a public hospital, Mary Greeley Medical Center is accessible to everyone. But the uninsured certainly have a challenge in obtaining medical care." The folks who fall through the cracks are those who aren't pregnant, don't have dependent children, aren't disabled as defined by Social Security and not over age 65. "The short definition is kid-less adults or kid-less adult males," Crow said. "Their options are very limited." Access is becoming an issue for Medicaid patients who need dental care. Crow said that as of now, his office must choose the option of referring Medicaid dental patients to the University of Iowa Dental Clinic. "The university clinic will see people, but it's in Iowa City, and some folks don't have the means to get there," he said. Bob Zientara can be reached at 232-2160, Ext. 487, or rzientara@amestrib.com.
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