Doctors – from internists to specialists – are increasingly unwilling to accept new Medicare patients, and many are opting out of the program completely.
In Colorado Springs, 5,000 Medicare patients were left with no primary care doctor when the Colorado Springs Osteopathic Foundation closed.
Many doctors opt out of Medicare because of the “hassle factor,” said Carol Walker, executive director of the El Paso County Medical Society.
“It’s a complex question,” she said. “Doctors are small business owners, and they have to do what’s best for their business. The reimbursement rate is low, and keeping track of the rules and regulations is very difficult. It’s hard to keep the doors open if you take Medicare.”
The lack of physicians has Medicare patients seeking treatment in the only alternative place: the emergency department.
“We see a disproportionate number of seniors in the emergency room,” said Teri Mandell, director of emergency and critical care at Penrose-St. Francis Medical Center. “It’s a statewide issue – we’ve seen a dramatic decline in doctors that take Medicare because of the low reimbursement rates. As a result, if they can’t get into a senior clinic, they come to the ED for their acute needs.”
Penrose has seen the number of Medicare patients rise 3.8 percent during the past year, but also have seen an overall increase in emergency room visits of 4.2 percent – which means the department is seeing about the same number of Medicare patients each year.
The problem isn’t just in Colorado.
Last year the Medicare Payment Advisory Commission said that 29 percent of beneficiaries had trouble finding a doctor – up from 24 percent the year before.
Nationwide, about 40 million Americans have Medicare, and addressing the scarcity of doctors will become important as the baby boomer generation ages.
It’s an issue that various groups are trying to address.
Peak Vista Community Health Centers is planning a new senior clinic, and Kaiser Permanente plans to open a senior clinic for its Medicare Advantage patients near Memorial North.
Kaiser expects to treat 1,300 patients this year and 1,000 to 2,000 more next year, said Mark Iorio, executive director of network development and market expansion for Kaiser Permanente Foundation Health Plan in Colorado.
“We are uniquely positioned for this,” he said. “Seniors are having trouble assessing senior services – who is better positioned than Kaiser to offer services to people with senior advantage insurance? We’re an insurer and a provider of care.”
Kaiser operates a similar senior center in its Denver-Boulder market, and Iorio said the company has plans to open one in Pueblo as well.
The center will be an “attractive option” for seniors, he said.
“It’s going to address full services at one site – optical and hearing services, lab services, x-rays,” he said. “We’ve been successful with health and wellness programs in Denver, and we’re going to duplicate that here.”
But Kaiser’s solutions won’t solve the problem, Mandell said.
“It’s really bigger than that,” she said. “Kaiser traditionally hasn’t had a large number of members in El Paso County, so we expect we’ll still see a large number of seniors in the emergency room.”
Kaiser certainly sees an opportunity, Walker said.
“It’s a business model – and one they think the time is ripe for,” she said. “And it certainly could be. There are things – nothing focused yet – that could make it easier for doctors to take Medicare.”
In fact, some of the CEOs of the larger health groups in the Springs – Colorado Springs Health Partners, Mountain View health clinics – have started accepting new Medicare patients, she said.
“We see on the horizon some changes, some amount of hope,” she said. “There are some changes coming that will make it more efficient, fewer regulations, less complex. But they’re not here yet.”
Amy Gillentine covers health care for the Colorado Springs Business Journal.