A survey of Colorado primary care doctors found most are reluctant to take a new patient on basic Medicare, the government health insurance for people 65 and over.
Colorado Public News called family, general practice and internal medicine physicians across the state, using the nation’s official website that lists thousands of doctors the site claims treats patients on Medicare. Of 100 contacted, only 34 said they would readily accept a new patient.
Of the remainder, 40 said they would not add a new patient on traditional Medicare. Another 26 limit new clients, making decisions on a case-by-case basis, or placing patients on waiting lists of up to six months. That adds up to 66 – or two-thirds – refusing or limiting new patients.
The questions focused on traditional Medicare, which is used by most recipients.
Several doctors said they hesitate to take Medicare patients because Medicare doesn’t pay enough, pays late, and can require a nightmare of paperwork and repeated telephone calls.
Studies have shown that people are healthier when they have a “medical home” like a primary care doctor, so this reluctance to accept basic Medicare can have a major effect on the health of many of the roughly 450,000 Coloradans using it for their insurance. It comes on top of Colorado’s general shortage of primary care doctors for all patients of all ages.
After 15 years, physician quits his patient
Robert Tooke, who is 60 and disabled, was stunned when he received a letter from his longtime endocrinologist informing him that he and other patients on Medicare were being dropped from further coverage.
Tooke immediately began looking for another doctor. By the time he was done, he had contacted 31 physicans.
“One. One called back,” Tooke said in an interview at his Aurora apartment.
The letter did not state why Tooke and other patients were being dumped. Tooke’s doctor did not return several calls from CPN.
Though Tooke finally found an endocrinologist, he worries he could be dropped again.
“Once in a while you run into a really fantastic doctor and when you do you grab on and hold on as long as you can,” he said.
The findings contrast sharply with the government’s statement that 94 percent of Colorado physicians take Medicare. Colorado Public News found that while many doctors may be signed up for Medicare, or be paid by Medicare for a certain number of patients – that doesn’t mean those doctors will accept any new patients.
The problem is pervasive enough that at least two Colorado organizations are keeping their own lists of which doctors take new Medicare patients.
“Clients would call here and ask” because they were having trouble finding a doctor, said Carol Mesaros, a volunteer with Mesa County’s RSVP, a nonprofit that helps seniors. RSVP found that about half of the 71 doctors it polled in the Grand Junction area are willing to take new basic Medicare patients.
In Denver, St. Anthony Hospitals’ Health Passport office keeps a list of 300 doctors who will accept a new Medicare patient.
Dr. Jonathan Zonca, of Ascent Family Medicine in Denver, is taking new Medicare patients. But he said he hesitated after figuring out that Medicare had paid half of what other insurance plans did, over three years.
“That’s a real hard way to make money and pay our staff and pay our rent, especially in Denver – it’s pretty expensive rent,” he said.
Medicare also pays more slowly than other insurance plans, doctors say. Ascent has been waiting more than six months for $55,000 due from Medicare, Zonca said. Medicare officials have provided no assurances that the payments will ever come, he added.
The problem? Ascent recently changed its name.
“The hold-up is simply their paperwork and inability to complete timely credentialing, which all other insurance plans have done within a week or two – at the most, a month,” Zonca said. “Medicare is the only one that’s outstanding.”
Medicare’s anti-fraud auditing has even honest doctors worried that they’ll run into trouble if they make errors with the agency’s complex billing.
Doctors also are reluctant to take on new Medicare patients because older patients tend to have more complex medical issues, require more time during office visits and may need extensive follow-ups that Medicare may not cover.
“By definition, they’re elderly or disabled and harder to treat,” said Dr. Barry Martin, vice president of clinical affairs for the Metro Community Provider Network, a nonprofit that runs 12 health centers around the Denver Metro area. The group does accept new Medicare patients, partly because it is a nonprofit and collects grants to help with the bottom line.
Mike Fierberg, a spokesman for the government agency that oversees Medicare – the Centers for Medicare and Medicaid Services – was “overall not surprised” by the findings.
He said doctors are wary of Medicare patients because in recent years Congress has repeatedly come close to slashing Medicare funding – most recently by 27 percent – only to back down at the last minute.
“It’s a challenging environment for a physician to operate a small business,” Fierberg said.
Several doctors also cited this unpredictable political climate as a reason to shy away from Medicare patients.
The Medicare agency does not gather data regarding which physicians take new patients at any given time because “any such data would not have a lot of meaning by the time it would be compiled and released,” Fierberg added. “Physicians can decline any patient on a day-to-day basis.”
Liz Tredennick, a counselor at the St. Anthony Hospitals Health Passport Office, advised patients who have traditional Medicare not to wait until they are ill to find a doctor.
“Keep looking around and making phone calls,” she said. “Ask your friends, ask your neighbors.”