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October 31, 2014

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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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  1. This is a preview of what will be occurring via Obamacare. It will be (already is) a disaster. OBAMACARE MUST BE REPEALED!

  2. Huh, who knew?...

  3. Superbad

    Thank you for actually UNDERSTANDING what Medicare is all about. People like Mr. Hopkins are ignorant to the facts on what Medicare is. And that's too bad. I believe there are MANY people in this country who voted in all these Tea Party candidates who do not have a basic understanding on programs that have been around for years. My guess Mr. Hopkins doesn't get "Social Security" either.

  4. people voted back in the gop so dont be suprised when this is what you get.

    the gop wants to balacne the budget so we cant afford medicare sorry

    we got fix the tax code so you cant write off your mortage intrest anymore...

    all these types of programs to save money cost the low income and middle class

    but they still want the bush tax cuts for the richest 1% cuse they make jobs

    what a joke only the poor and middle class have the make scarafices and curb our essentail services not the rich guys they need a tax break. i love how rep push this on us saying its better for the country!! its not better for 99% of us just the upper class.

    but dont worry poor people vote rep cuse they think one day they will be rich.... you guys voted for this so dont complain now just man up as they say and wait till next election hopfully you learn your lesson but you wont.. the gop will say its obamma's fault and sara pailn can fix it keep listening to fox news there for our best intrests

  5. I would gladly give up my mortgage interest deduction on all four of my mortgages for a public option.

  6. In 1997, when Congress "Balanced the Budget" by mandating future cuts in Medicare, Newt Gingrich was Speaker of the House. That means that Republicans, yes, Republicans, were the majority in the House of Representatives then. Also, the Majority Leader of the Senate in 1997, when this "budget-balancing" mandate by future Medicare cuts was enacted, was Trent Lott, also a Republican. This current looming disaster which will cause certain death to many Medicare patients currently on dialysis and chemotherapy, and will cause health problems for the vast majority of other Medicare patients is the direct and proximate result of political posturing by Republicans who were in control 13 years ago. This is mass death without death panels. The extensions have been granted by Congresses controlled by Democrats.

    Many members of the stampeding electoral herd won't live to see the next election. But it will reduce the deficit. Are we truly back to hunter-gatherers who just leave their elderly (and the unemployed) on a rock and wish them farewell? Whatever ideology supports this, it isn't Christian.

  7. It would be Arizona leading the way. I guess the Republican Governor, and the Republican Legislature felt they had to lead the way for the Federal Government once again. In the name of balancing the state budget, Arizona has stopped paying for organ transplants in its Medicaid program. There is a stanza from an old spiritual that goes something like this: "If religion was a thing that money could buy, the rich would live and the poor would die. All my trials, Lord, soon be over."

    Arizona has abandoned Christianity for Mammon. Will Nevada follow?

  8. Det_Munch

    The GOP hasn't even taken control of the House and already you libs are blaming them for the cuts in Medicare which have been caused by the Obama administration. More lib denial on display here. The GOP actually DOES understand what's wrong with Medicare and SS and they want to fix them. It's the libs who have put them in near bankrupt status. Already many doctors are refusing Medicare patients because of the provisions in Obamacare. I suggest that you are the ignorant one, Det_Munch. Ignorance, denial or both on display here.

  9. Superbad:
    It is the HIGH COST of health care which the GOP intends to address, among other inefficiencies, AFTER they repeal the monstrous boondoggle of Obamacare which has little to do with health care and much to do about People-control. Your denial that Obamacare cuts $500 billion out of Medicare shows your ignorance or bias or both.

  10. Some of the commentors on this page must not have read the article about how doctors are getting out of the Medicare business. Libs keep repeating their talking points and the same old tired mantra about how conservatives want to starve grandma, take away her health care, Social Security and make her eat dog food. This rhetoric is so old and tired. I wish the libs could catch-up to the current reality and realize that it is Obamacare that is causing these doctors to opt out of Medicare and it is Obamacare that is the current enemy of seniors.

  11. Mr. Hopkins

    "Obamacare" as you call it has not taken effect yet to the extent that doctors are bailing on Medicare patients or that it is the "enemy" of seniors; in fact, some provisions added to Medicare this past year are going to HELP seniors, thanks to the current administration. My understanding is that the doctors are bailing because Medicare cannot reimburse them for all the services they are providing. This started way before "Obamacare" was signed. Same goes for in-home health care payments. THIS is because the gov't has overextended itself in so many other ways and cannot afford to pay the doctors and inhomehealth care agencies or so many other programs out there to help the seniors; I believe they are called "Budget Cuts". This is something that started way before Obama became President.

    Medicare premiums have gone up for seniors starting this year regardless on how much the senior gets for Social Security. If the senior gets $500 a month, he STILL has to pay the $110 Medicare premium out of that $500; same with someone who gets an exhorbitant amount of Social Security, ie a few thou a month (which IS going to stop as I understand - first recipients of Social Security cuts - those who get TOO much), that person pays the $110 also. The only good thing is that that person can afford the secondary insurance, whereas the first person will struggle to be able to afford the secondary insurance.

    I would suggest you read up more on Medicare and Social Security, Mr. Hopkins, before you continue critizing all of the "libs". And by the way - "Grandma" these days most likely could kick your ass! "Grandmas" and "Grandpas" aren't what they used to be!!! Go check out a gym one of these days....

  12. Ignorant RepubliCONs posting here (shocker). Most health care reform provisions have not taken place nor will take place for years (due to the Greedy OLD Party of NO). A Public Option would have balanced this reform!

    Can any of you RepubliCON minions name one time when a RepubliCON has mentioned ANY phrase about helping the Middle Class or Poor. RepubliCONs are crooks out to give away 700 BILLION DOLLARS of our working Americans TAX money to Billionaires and millionaires (out of the other side of their mouths, CONs say they are concerned about the deficit). BS!

  13. Congressional leaders would quickly come up with a solution to this problem if their health care benefits were being cut.

  14. To Det_Munch:
    Obamacare is, indeed, already being implemented and the 2400+page bill has already created more than 2500 pages in additional regulations just in implementing the first phase. Yes, doctors are bailing because Medicare reimbursements are reduced under Obamacare. Obamacare also imposes new taxes on certain procedures and medical supplies used mostly by the elderly. Obamacare cuts $500 billion from Medicare. It establishes so-called "death panels", although libs deny that. Yes, some doctors refused Medicare patients before Obamacare but now it is accelerated because of the provisions in the boondoggle bill. And, I already have "read-up" on Medicare and I know that some corrective measures are needed. But, Obamacare makes things worse, not better. Sounds like you believe the BS in Andy Griffith's Medicare commercials. Thanks for your effort to educate me on Medicare, SS, etc. But I am already on both so I can differentiate between the truth and the BS and I am living in the reality of what's going-on. And, if grandma wants to kick my ass, I will buy her a glass of buttermilk instead.

  15. To "tryhonesty":
    I know it's futile arguing with you libs, but we are all in this mess together so continuing this forum is important. You are partially correct in what you say about most ofthe benefits of Obamacare being implemented down the road (2014). But it is being front-loaded with the costs which were originally around a trillion. That figure is closer to 2 trillion already.Remember that a "public option" is really a government option. The ultimate objective of the libs is to completely control ALL of our healthcare. Do you support Obama's $250K threshold for being "rich"? Don't you realize that many thousands of small businesses are in that group? Are you for further hampering small businesses where most of the jobs, which we desperately need, are created? And, what the GOP wanted Obama to do instead of initiating his $trillion porkulus package was give a "tax holiday" to taxpayers and let us use that money to spend as we saw fit. That would have stimulated the economy. Would that not have helped the middle class and poor? Surely you are aware that the "Party of No" was powerless to stop the Obama train of destruction, aren't you? Obama and the Democrat Congress own this economy. The Democrats have had control of Congress for the past 4 years. How's that working out for you?