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Hunting for health care

October 12, 2003 1:07 am

If you're new to the fast-growing Fredericksburg area and trying to find a primary-care doctor, your search could be a difficult one.

If you're new and a senior citizen, it will be even tougher.

Several of the area's primary-care doctors have closed their practices to new Medicare patients because of low reimbursements. Seniors who have just moved to the area and those changing doctors are the most likely to be affected.

Pat Carmine, a 67-year-old Falmouth resident, called seven local doctor offices last month before finding one that is accepting new Medicare patients. Carmine said she and her husband, Joseph, also 67, had been seeing a Richmond doctor, but wanted to switch to someone closer to home.

The family considers Medicare to be their secondary insurance, she said, since her husband is employed and has insurance through his work.

"It didn't make a bit of difference," she said. "It was very frustrating."

A recent Free Lance-Star phone survey of 26 family-practice and internal-medicine offices also found fewer choices for seniors. Ten of the offices said they were not taking new Medicare patients. One office requires new Medicare patients to take an entry physical, to weed out those who are deemed too sick.

Medicare is the federal medical insurance program for people 65 or older and those with disabilities. In a region like Fredericksburg, with 20,000 seniors, it is an important part of the medical landscape.

Pat Holland, senior services coordinator for the Rappahannock Area Agency on Aging, said she has long advised seniors who are thinking of moving to the area to make sure their insurance and prescription plans work here. Now, she also advises them to check on the availability of a doctor.

"Two years ago we wouldn't have thought about it," she said.

Holland recently met an elderly couple from Ohio who moved to the Fredericksburg area to be near their adult son. The couple figured they would see the same doctor who cared for their son, but were surprised to learn he was not taking new Medicare patients. They eventually found another doctor and are happy with him, Holland said.

This shrinking pool of doctors who take new Medicare patients is occurring as the area has sprouted several new retirement communities. Falls Run on U.S. 17 in Stafford County is the largest of these projects, though similar developments, such as Legacy Woods and the Villas of Salem Fields, are under way in Spotsylvania County.

What the residents of these new subdivisions will discover is that they are unable to enroll with physicians such as Dr. Philip C. Casey.

Casey, a Fredericksburg internist, takes some new patients, depending on their insurance plans, but not new Medicare patients.

"I just don't want to see that population grow in my practice," he said.

Casey is president of the Fredericksburg Area Medical Society and has participated in the Medicare program since 1994 when he opened an office in Fredericksburg.

He continues to participate in the program, and about 50 percent of his patients are insured by Medicare. But he decided last year to stop accepting new Medicare patients.

"Over 50 percent makes me nervous," he said.

The problem for Casey and many other doctors is the low reimbursement offered by Medicare and the prospect of additional cuts. A doctor who sees a Medicare patient might receive $35 for an office visit. The same office visit for a patient insured by one of the private insurance plans could pay $55.

Casey said Medicare is his second lowest payer, after Medicaid, the government health program for the poor. And an additional cut in the program averaging 4.2 percent is scheduled for next year.

Limiting the number of Medicare patients is a matter of "self-preservation," he said.

Medicare's reimbursements are tied to the economy and fluctuate from year-to-year. In good years, such as 1998 through 2001, reimbursements rise. In bad years, payments drop.

Payments dropped by an average of 4.8 percent in 2002. This year Congress intervened to stop another decrease. Instead, rates rose an average of 1.6 percent.

"It's a flawed formula," Casey said.

Many Medicare recipients have purchased a supplemental policy, but that does not make them any more attractive as patients, Casey said. Supplemental plans help pay the portion of the bill not paid by Medicare, but they do not increase the amount going to the doctor, he said.

That amount is set by Medicare and is not subject to negotiation. It is also the basis for payments by many other health insurance plans. If Medicare raises or lowers its reimbursement, other plans do likewise.

Dr. Bozena Wolanska agrees with Casey on Medicare's problems but has decided to continue to take new Medicare patients. She opened an internal medicine practice in Fredericksburg four months ago.

"I'm building up my practice," she said. "The doors are open for all insurances."

But Wolanska also said that the elderly are the heaviest users of medical care and must have access to regular care.

"We will all be Medicare patients someday," she said. "I hope somebody will see me."

The American Academy of Family Physicians reported in August that nearly one-fourth of its members no longer take new Medicare patients. This percentage has risen steadily since 1999, according to the AAFP. In the late 1990s, the number was dropping.

The change reflects a frustration with Medicare's rates and regulations, said Dr. James C. Martin, chairman of the board of directors of AAFP, in a phone interview.

Doctors are small-business owners, who fear that growing numbers of Medicare patients will endanger the financial health of their practices, said Martin, a San Antonio physician.

"It's a simple equation," he added. "If you want access to care, revenues have to exceed expenses."

To reach JIM HALL: 540/374-5433 jhall@freelancestar.com