Doctors cut intake of Medicare patients

Lower payments fail to cover their care costs for the elderly, many say

March 17, 2002|By NEW YORK TIMES NEWS SERVICE

WASHINGTON - For the first time, significant numbers of doctors are refusing to take new Medicare patients, saying the government pays them too little to cover the costs of caring for the elderly.

Medicare cut payments to doctors by 5.4 percent this year. The government estimates that under law, the fees paid for each medical service will be reduced in each of the next three years, for a total decrease of 17 percent from this year to 2005.

For years, doctors have expressed frustration with Medicare, grumbling about reimbursement and complex federal regulations. But the latest reaction appears to be different. Doctors are acting on their concerns, in ways that could reduce access to care for patients who need it.

For example, some doctors are purposely limiting the number of their Medicare patients. The American Academy of Family Physicians says that 17 percent of family doctors are not taking new Medicare patients.

Mark H. Krotowski, a family doctor in a working-class neighborhood in New York, said: "My expenses go up and up and up every year. For the government to lower what it pays me when my expenses are rising - that doesn't make sense. It's an insult."

Krotowski said that about 25 percent of his patients are on Medicare but that he was not taking any new Medicare patients.

"I love my elderly patients," Krotowski said. "But they are very sick. They need a lot of attention, a lot of medications and a lot of time. Medicare reimbursement has not kept up with inflation or the cost of providing care to the elderly."

The government is continually struggling to control Medicare costs. Total Medicare spending rose 24 percent in the past five years, to $238 billion last year, and the Congressional Budget Office has predicted that it will grow to $310 billion in 2006. Spending for doctors' services accounted for nearly $41 billion of last year's total.

Dr. Baretta R. Casey, a family physician in rural Pikeville, Ky., near Ashland, did exactly what the government encouraged doctors to do, setting up practice in an area where doctors were in short supply.

"For the last five years," Casey said, "I've watched my income go down and my expenses go up. About 60 percent of my practice is Medicare patients. I decided not to take any more Medicare patients in January, when the reimbursement rate was cut."

Casey, like many doctors, said the cut was magnified because many private insurers link their payments to the amounts paid by Medicare.

Health policy experts said the cuts could make it more difficult for elderly people to find doctors just as the need increases with the aging of the population. Medicare covers 40 million people; the number is expected to double by 2030.

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