Access To Primary Care Is A Challenge For Some Texas Medicare Patients

The annual congressional battles over the “doc fix” and the threats of lower reimbursements in the future have left some Texas doctors insecure and unwilling to take on more Medicare patients.

A transcript of the Newshour video report follows.

RAY SUAREZ: Now: doctors opting out of Medicare.

Much of the political talk on Medicare focuses on its rising costs. But, for some patients, there are growing concerns about how hard it is to find a doctor.

Once a month, these seniors get together at the public library in South Austin, Texas, to talk about what’s going on in their lives. This week, Medicare looms large.

WOMAN: I wonder, where would my friends and neighbors who are retired be if it weren’t for Medicare?

MAN: It’s a crisis, especially in the primary care area.

RAY SUAREZ: What they’re talking about is how it’s getting harder and harder to find doctors who will treat Medicare patients.

For one of the group’s members, 78-year-old Nancy Martin, the search was particularly tough. After moving here from Lubbock in 2007, she spent hours calling primary care doctors.

NANCY MARTIN, Texas: I said, I’m Nancy Martin. I have just recently moved to Austin. I am looking for a physician that will take a new Medicare patient. Sorry, we don’t take any new Medicare people.

I felt frustration, disappointment, I would say despair, a lot of days, just get to the point where I thought, I’m never going to find a doctor in Austin. What do you think I will have to do? I don’t know.

RAY SUAREZ: Martin has high blood pressure and type 2 diabetes.

NANCY MARTIN: If I had something bad, I just went to the emergency room.

RAY SUAREZ: After two years of searching, Martin finally found a primary care physician.

MAN: It’s nice to see you today.

MAN: Thank you.

Medicare Doctor Pay

FAQ: Why Is It So Hard To Fix?

RAY SUAREZ: There are differing estimates on how widespread the access problems are for Medicare recipients nationally. Only a handful of health organizations have even tried to study the issue. Texas has one of the few state medical associations that has.

LOU GOODMAN, Texas Medical Association: Patients are having a much harder time getting — finding a doctor who will accept Medicare.

This is Lou Goodman.

RAY SUAREZ: Lou Goodman is the CEO. With 47,000 members, it’s the largest state medical society in the U.S.

LOU GOODMAN: And in 2000, we had about almost 80 percent of the doctors were taking new Medicare patients. We just completed a survey last year, and we found that less than 60 percent were taking them. Almost 20 percent fewer doctors are taking new Medicare patients. And that really troubled us.

RAY SUAREZ: Goodman says the primary reason doctors are not taking new Medicare patients or opting out altogether is because of something called the sustainable growth rate.

It’s a mathematical formula established by Congress in 1997 to contain rising Medicare costs. But, in practice, it would have cut government payments to physicians for treating Medicare patients every year since 2001. So, every year, Congress at the last minute passes the so-called doc fix, averting the cuts and giving doctors a small raise.

The annual doc fix and the threats of lower reimbursements in the future have left some doctors insecure and unwilling to take on more Medicare patients.

Tricia Neuman tracks medical for the Kaiser Family Foundation.

TRICIA NEUMAN, Kaiser Family Foundation: Over the years, a number of problems have emerged with the formula. And it has resulted in a threatened reduction in payments for physicians each year. So, this year, for example, had Congress not taken action, physician fees would have been lowered by 30 percent approximately. And nobody really wants that to happen.

RAY SUAREZ: Congressional leaders have talked about passing a permanent payment fix. But each time they get close, they have been scared off by the estimated $138 billion dollar price tag. That’s left some physicians to make tough decisions.

MAN: Anybody sick at home?

RAY SUAREZ: Last year, the Austin Regional Clinic, or ARC, bit the bullet and stopped taking new Medicare patients.

ARC, one of the largest health care groups in Central Texas, serves more than 400,000 area residents. Dropping Medicare wasn’t something the health system wanted to do, but CEO Dr. Norman Chenven says it was an economic necessity.

DR. NORMAN CHENVEN, Austin Regional Clinic: The issue was really one about survival.

It’s really time and materials that it takes to provide care to someone. We can pretty much predict that if our Medicare population grows beyond a certain percentage that our profitability is going to go away.

RAY SUAREZ: The Texas Medical Association says this chart tells the story. Since 2001, Medicare payments to hospitals and nursing homes have steadily gone up. But those to physicians have remained flat.

Meanwhile, the cost of running a practice, according to the Texas Medical Association, has increased between 25 and 50 percent. But it isn’t just money that is driving the exits. Two hours west of Austin in the Texas hill country, Dr. Janet Chene says it was government rules and stepped-up audits for fraud that drove her to stay out of Medicare altogether.

DR. JANET CHENE, Family Physician: I didn’t see any way that I could stay in that program and give my patients the level of care that I want to give them.  

RAY SUAREZ: Dr. Chene says Medicare criticized her for spending too much time with her patients.

DR. JANET CHENE: I’m a family doctor. I’m not a specialist that’s been just taking care of their toe or their eye. This is the oldest, sickest part of our population. And I felt I was being pushed to herd them through in a turnstile way in 15 minutes or less.

RAY SUAREZ: Medicare makes up nearly a quarter of the nation’s health care spending on physician services, according to the Centers for Medicare and Medicaid services.

Chene says even though she stopped taking those seniors, she doesn’t believe they have had trouble finding another doctor. And Kaiser’s Tricia Neuman says their research indicates it’s not a widespread problem.

TRICIA NEUMAN: We just did a survey last year. And, in fact, only three percent of seniors said they had trouble finding a doctor who would take Medicare. There could be certain situations where a senior may not be able to get their first choice in terms of physicians, but, in general, there are physicians available who would see them.

RAY SUAREZ: The independent Medicare Payment Advisory Commission also looked at the problem last June. Of the six percent of seniors they surveyed looking for a new primary care physician, one in four had a small or big problem getting an appointment. And Medicare itself says fewer than 10,000 doctors have officially opted out of the program in the past two years.

But Texas Medical Association’s Goodman thinks that’s just the tip of the iceberg.

LOU GOODMAN: I think we’re going to have a real shortage and a real problem. There is data — there are data on both sides of that argument. Our surveys show that we’re going to have a huge influx of seniors, but also not enough doctors to take care of them, no matter what.

I think what could happen is, our emergency rooms could get flooded. And, as we know, emergency rooms are the costliest place to get care.

RAY SUAREZ: Dr. Chenven says making a permanent doc fix isn’t all that needs to be done to keep physicians in the Medicare program. Doctors get paid by Medicare based on fee-for-service. Each service is paid for separately, giving incentive for physicians to provide more treatments, regardless of the outcome.

DR. NORMAN CHENVEN: That has to change for us, for this country to figure out a better way to deliver care.

RAY SUAREZ: Every day, about 10,000 Americans turn 65. And it’s estimated more than 25 million new Medicare recipients will be in the program by the year 2020.

The fight over the sequester could add even more complications. Physicians are bracing for a 2 percent cut in Medicare payments starting Apr. 1st.

Online, we look at another source of doctors’ frustration, a new system requiring specific codes for everything from flaming water ski burns to dolphin bites. That’s on our Health page.