Traverse City Record-Eagle

December 16, 2012

'MediScare' limits Traverse City area patients

BY ANNE STANTON
astanton@record-eagle.com

TRAVERSE CITY — A very pregnant Felicia Evans and her husband recently drove nearly 40 miles to see her doctor at the Munson Family Practice Center.

Cadillac is much closer, said Evans, of Mesick, but her last doctor there failed to perform even the basics — taking her blood pressure and weight, and prescribing prenatal vitamins.

"When we went to find someone else in Cadillac, they told us they were all filled up," said Evans, who carries Medicaid insurance.

Medicaid patients like Evans are covered by a state program for the poor but have long found it hard to get through private practice doors. Now access seems to be tightening for Medicare patients, too.

In a consumer quandary oft-referred to as "MediScare," some doctors are refusing to see new Medicare patients until they determine how reimbursement rates and regulations shake out next year. About a quarter of area family practices are refusing any new Medicare patients, according to HealthLink, a Munson Healthcare service that connects patients to physicians.

Medicare, a federal insurance program for seniors, pays about 20 percent less than private insurance companies, yet can still be lucrative — particularly for practices that cater to elderly patients. Doctors worry about the so-called fiscal cliff. If sequestration kicks in, providers will see an immediate 2 percent cut in reimbursement rates.

And thanks to bad timing, Congress must also decide on a 27 percent reduction in Medicare reimbursement rates to doctors, owing to a 1997 law that ties rates to the nation's GDP growth.

Congress overrides the cuts each year in what's called a "doc fix." This year it carries the heftiest price tag ever of $25 billion. Fixing the problem for good would cost $300 billion, according to a November 26 NationalJournal article.

"It's a scary time," said Melissa Slepicka, administrator of Tendercare Heathcare-Birchwood, a senior care facility in Traverse City. "There are a lot of rumors out there as much as fact. It's hard to weed through all the information that's being thrown out there."

It also creates a kind of paralysis when making staffing and equipment decisions, said Jeffrey Wentzloff, an ophthalmologist and co-owner of Grand Traverse Ophthalmology.

"You have a looming, potential cut in your revenue, and it has a trickle-down effect," Wentzloff said.

Even after immediate problems are resolved, core questions of doctor access likely will linger, thanks to uncertainty surrounding aspects of the national Affordable Care Act.

Dan Webster, a physician at Munson Family Practice, understands why some physicians are capping the number of Medicare patients.

"ObamaCare is a big legislative package — over 2,000 pages," he said. "We don't know the policies and procedures and how they'll affect us individually as a provider, and how it affects our patients. It is meant to improve access to care, but it remains to be seen."

On the bright side, the Affordable Care Act requires states to significantly ramp up Medicaid reimbursement rates to primary care physicians for the next two years, to the same level of Medicare rates. And that's good news not only for patients like Felicia Evans, but for their doctors, as well.