Alaska can do more to help those on Medicare

Posted: Sunday, November 21, 2010

Alaskans on Medicare deserve some help. A recent survey by the University of Alaska confirms what many seniors know from experience. If you're over 65, and rely on Medicare, most general practice, or "primary care" physicians won't see you. It's a problem that is most acute in Anchorage, but is starting to spread across the state. It's a problem we should fix.

Until last year the state had an excuse not to step in. Medicare is a federal program that doesn't allow much state intervention. But last year that changed a little, thanks to a provision some of us worked on with U.S. Sen. Mark Begich (D-Alaska), and that he succeeded at passing last spring. His amendment clarified that states can offer competitive grants to medical providers who'll agree to see more seniors, and help solve the medical provider shortage. The state doesn't have the power to re-do Medicare, but we can choose something better than the status quo -- leaving too many seniors without appropriate medical care.

To craft solutions, you need to understand the problem. In Alaska the federal Medicare reimbursement rate has been set artificially low for many services. Primary care, or general medical visits must get billed under the Medicare "office visit" code. Most primary care practitioners truly lose money by taking Medicare patients. Some choose to lose money out of their duty to serve. Other physicians, and non-physician medical providers face similar problems.

Why has this been so hard for the Alaska delegation to fix? Because federal reimbursement rates differ around the nation. This federally-set rate is fair in many places, and is not as big a problem for the constituents of other senators.

A recent University of Alaska survey in Anchorage shows only 17 percent of primary care physicians will treat new Medicare patients. Roughly 47 percent only treat those who started seeing the physician before they turned 65. The rest have to forego treatment, seek treatment at an inadequately funded community health clinic, go to the emergency room or pay out of pocket. This problem was worse before this year, when Sen. Begich, like Sen. Ted Stevens before him, was able to secure a modest rate increase in the health care bill.

Skeptical that medical providers really lose money under Medicare in Alaska? I was skeptical at first. But after study, and hearings our office organized two years ago, it became clear that certain Medicare reimbursement rates result in real financial loss to providers. Here's some evidence. Medicare allows "community health centers" to bill office visits at a roughly 35 percent higher rate than private doctors can. Anchorage's community health clinic barely breaks even at that higher rate.

States are allowed few, but real options to help under the Medicare statute. We can provide more treatment by helping Alaska's community health clinics to treat more people. We can do what the Legislature did last year, and subsidize the development of private Medicare clinics. And Providence Hospital is willing to lose money by moving forward with another. All these options need to be part of the final puzzle, but they won't solve it alone.

The Begich amendment allows us another option. Until it passed, the federal government interpreted the law narrowly, and was hostile to attempts by states to supplement the Medicare reimbursement rate. I filed legislation in 2009 to try to get around that prohibition, and was told by federal authorities that it would not be allowed under the Medicare statute. We then began work with Sen. Begich to find a way around this problem. Rep. Lindsey Holmes' (D-Anchorage) helped in our work with Sen. Begich.

The Begich amendment now makes clear that states have broad leeway to devise grants to primary care providers. Alaska has the leeway to devise a competitive grant that targets providers who would otherwise lose money by taking on Medicare patients. I'd envision that it would go to the providers who will expand services to the most seniors, for the least amount of grant funding.

The law allows for other approaches, as well. In January we should work together so that seniors who need medical care, get medical care.

Rep. Les Gara is a Democratic member of the Alaska Legislature.

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