The Doctor is Out

This story won the SPJ contest for social issue reporting. Of all the awards I've received, that one is probably the one I'm most proud of.

Published March 9, 2006, in the Keizertimes

When Arlene Blake's mother-in-law, Eva, first mentioned not being able to find a local doctor, Blake was dismissive.

"I figured you call and you sign up. End of story," said Blake.

But as a patient insured only by Medicare, Eva was facing a problem that is on the increase not just in Keizer, but in Oregon and across the country. Fewer and fewer doctors are accepting new patients if they are insured only by the federal health insurance program.

Arlene called all three general practice firms in Keizer and not one was accepting new Medicare patients.

In recent months, the public spotlight regarding Medicare has been on the new Part D prescription drug coverage plans. Several months ago, state Rep. Darlene Hooley held an informational meeting at the Keizer-Salem Area Senior Center and more than 300 people turned out to learn about the new coverage. Television and radio commercials continue to urge seniors to sign up for the Medicare Part D prescription plan.

But in the shadow of that effort, a growing number of seniors are struggling to find doctors to see them, let alone prescribe medications.

At the same time Blake was discovering the problem in Keizer, Marc Adams, Keizer's police chief, was expanding his search for care for his in-laws.

"They moved up from Coos Bay, and we thought it would be a piece of cake to find a doctor compared to there," Adams said.

Adams began his search in Keizer and expanded it to Newberg before finally finding a provider that would accept new Medicare patients, Providence Health Care.

"It just kills me that we drive right past Salem Clinic on the way there," he said.

The root of the problem, according to Geoff Stuckart, spokesman for U.S. Sen. Ron Wyden, is money.

"The reimbursement rate is insufficient for a doctor to choose a Medicare patient over someone with another type of insurance," Stuckart said.

Under the Medicare system, health care providers submit bills and Medicare sends payment directly to the provider. The payment is based on specific formulas for each type of care.

Adams was told by several clinics that the vast amounts of paperwork necessary to receive the reimbursement are not worth the hassle.

Doctors also feel under siege, said Dean Larsen, executive director of the Marion-Polk Medical society. The average general practice doctor in Marion County has more than 4,000 patients.

"And it's on the increase," Larsen said. "We have an older population that isn't getting younger and that means more office visits each year as they continue to age."

Nowhere to turn

In her search to find a doctor for Eva, Arlene came to despise the word "unfortunately."

"Every single conversation began with that word and no one could tell me where I might find someone who would take on my mother-in-law," Blake said.

The Medicare web site, www.medicare.gov, offers a list of providers who accept Medicare in the area, but makes no distinction between those who accepting new patients and and those who won't.

Adams investigated the possibility of adding additional insurance coverage, but when he approached the company paying for his in-laws' prescriptions he was told they could only have one or the other.

They opted to keep the prescription coverage, which pays for the ongoing costs.

"When I asked them what we were supposed to do when my in-laws needed a doctor, I was told to take them to an emergency room," Adams said.

That's advice that concerns local hospital officials.

"That's a terrible way to practice medicine, especially for people with chronic healthcare issues," said Sheryll Johnson Hoar, spokeswoman for Salem Hospital. "The best care happens when patients have a primary care physician."

In the past year, Salem Hospital has hired eight doctors to care for patients who come into the emergency room without a primary care physician, including a number of patients with Medicare coverage.

"They are patients who need longer care than the emergency room can provide, but the care ends when they leave the hospital," she said.

Hoar said all eight doctors have been kept busy since they arrived.

Adams even inquired about the possibility of being put on a waiting list at local clinics, but he was told that once patients with Medicare coverage die, they simply aren't replaced.

No solution in sight

Both Blake and Adams wanted to know what they're supposed to do for their elderly parents.

The answer from Stuckart isn't likely to please either one – they're working on it.

Stuckart said that the problem is a national as well as local one.

"The difference is that Oregon is feeling it more acutely than most of the rest of the country," he said.

Not all states start at the same reimbursement rate in the Medicare system because it is based on population size and Oregon has traditionally been at the low end of the spectrum.

Whereas other state medical programs have excesses to cut, "when Oregon makes cuts, we're cutting muscle and bone. We're being penalized for being efficient," he said.

Wyden and Sen. Gordon Smith have added the issue to their bipartisan goals, but Stuckart was unable to offer more concrete plans for a solution.

"We're trying to get the states like Oregon rewarded for their efficiency," he said.

For its part, Salem Hospital is attempting to recruit 150 new doctors into the area over the next 10 years, but Hoar said many of those will only replace doctors planning to retire in the same time frame.

"The fact is Medicare doesn't pay its part," she said.

Larsen said for those worried about the state of the system, it's time to put pen to paper and write their senators and representatives to request action for increased Medicare funding.

"It can't keep going this way," he said.

In the meantime, patients will continue to face long commutes if they are able to find doctors at all.

For Blake and Adams, there is also a growing uneasiness over what will happen to them when they reach their parents' age.

"If it's this bad now, how bad is it going to be then?" asked Blake.