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August 28, 2015

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On Medicare? Try the next office

Many doctors are dropping out of the federally funded health care insurance program, saying they can’t afford the cuts in reimbursement

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Christopher DeVargas

Dr. Frank Redfern explains to his patient, Walter Graham, the importance of a petition asking Congress to reverse planned cuts in Medicare reimbursements, Tuesday, November 30th, 2010.

Medicare Doctor

Dr. Frank Redfern explains to his patient, Walter Graham, the importance of a petition asking Congress to reverse planned cuts in Medicare reimbursements, Tuesday, November 30th, 2010. Launch slideshow »
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"When Medicare compensation drops below the cost to provide care ... you can't continue to keep the doors open," Dr. Fred Redfern says.

Inaction in Washington is causing Nevada doctors to turn away Medicare patients.

Congressional leaders have failed to set reimbursement rates for doctors who treat patients covered by the federal insurance system, so rather than face uncertainty over payments, some doctors are closing their practices to Medicare recipients.

As a result, elderly and disabled patients across the state — particularly in rural and Northern Nevada — are facing increasing difficulty finding doctors willing to treat them. Medicare provides coverage to those age 65 or older, younger people with disabilities and people of all ages with end-stage kidney failure.

This year, 12 percent of Nevada physicians have dropped out of the Medicare program, according to Larry Matheis, executive director of the Nevada State Medical Association. In a typical year, 1 to 2 percent would, usually because they retire or move, Matheis said.

“These are dramatic numbers and unlike anything I’ve seen in my 20-plus years,” said Matheis, who has traveled to Washington four times this year to lobby for a change in reimbursement formulas. “Very few doctors until this year left the Medicare program. It’s a dramatic failure on the part of Congress to ensure the sustainability of Medicare.”

Doctors face an almost 30 percent cut in Medicare reimbursements starting Jan. 1. A 23 percent cut was supposed to kick in Wednesday, but lawmakers agreed this week to delay it. It is the fourth such postponement this year.

A second cut of 6.5 percent is also scheduled to take effect Jan. 1. Medicaid reimbursements, meanwhile, have fallen more than 50 percent over the past 20 years.

“The government needs to realize that it’s not possible to absorb a 30 percent cut,” said Dr. Fred Redfern, a Henderson orthopedic surgeon. “Medicare reimbursements pay us close to our cost right now.”

In recent years, each proposed pay cut has been greeted by doctors threatening to opt out of Medicare. Each year, Congress holds off the cuts. Last year, when Congress missed its deadline, Medicare officials waited to process patients’ claims to avoid paying doctors the lower rate.

This year, doctors aren’t waiting for a patch. They’re dropping out of the Medicare system. And as practices begin to turn away patients, medical providers fear the situation is reaching a crisis point. Doctors who opt out of Medicare can’t return to the program for two years.

The doctors stress that their concern is not profit. They don’t expect to make much from their mostly low-income Medicare patients, they said. But they do need to pay staff, contract with labs and cover their rent.

“The No. 1 concern for doctors is being able to care for our patients,” said Redfern, who teared up while talking to a longtime patient about the potential effect of the cuts. “The most important thing is maintaining a patient’s access to care. When Medicare compensation drops below the cost to provide care, you don’t have to be a businessman to know you can’t continue to keep the doors open.”

Signs in Redfern’s office urge patients to call their representatives in Congress and tell them to reject the cuts. Redfern also offers patients petitions to sign.

Across the state, doctors have told patients that unless Congress acts, they may need to find new providers or pay for services out of pocket.

“Due to the possible expected ... cut in Medicare reimbursements, we may no longer accept Medicare insurance for health care coverage,” a note on the home page of Las Vegas Ob/Gyn Associates’ website reads. “Seniors, patients on disability and our military families will pay the price, with fewer doctors and less access to the care they have earned.”

The practice notes that one in four Medicare patients looking for a new primary physician report having trouble finding one. Several physical and occupational therapists in Northern Nevada have closed because of the financial uncertainty.

“You’ve got so many seniors who depend heavily on Medicare,” said 86-year-old Walter Graham, a Medicare recipient. “If you cut it out, what happens to us?”

Graham said at least two of his friends have had trouble finding doctors who will accept their Medicare payments.

The problem is expected to get worse. A survey of Nevada physicians by the state Medical Association found that 38 percent of doctors have limited the number of Medicare patients they’ll accept or have stopped accepting new Medicare patients. Another 42 percent said they are seriously considering opting out of the Medicare system if Congress cuts reimbursements.

About 300,000 people in Nevada receive Medicare benefits. Two-thirds are low-income, Matheis said.

Congress approved the reimbursement formula in 1997 as an attempt to curb skyrocketing Medicare costs. The goal was to keep doctors’ pay in line with national economic growth rates. After doctors took an almost 5 percent pay cut in 2002 as a result of the formula, Congress passed a series of patches to hold physicians’ pay steady.

Abandoning the reimbursement formula now would cost an estimated $300 billion over 10 years, which would have to be made up with other cuts in the Medicare program. The one-month patch comes with a $1 billion price tag.

The House tried to reform the formula last year but the measure died in the Senate because of its high cost. Senate Majority Leader Harry Reid also tried to legislate a fix but couldn’t muster enough votes.

“There are efforts to do something but so far there hasn’t been the will,” Matheis said. “It’s a Groundhog Day scenario. We seem to be constantly going through the same motions. All of them (in Congress) say we’ve got to fix it, but when the time comes, they don’t. And every year they kick the can down the road, the amount of money needed to fix it grows.”

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