You're in your late 60s and you've moved to Spokane to be near your children. You’ve found a place to live. You’ve found a grocery store, church and the other things that add to a person’s quality of life. But there’s a good chance you’re having a hard time finding a doctor who accepts new Medicare patients.

“There are really very few options left,” says Janet Monaco, CEO of the Spokane County Medical Society. Since Congress began reducing its Medicare reimbursement rates several years ago, many physicians have decided they can no longer afford to take on new Medicare patients.

“Most doctors will keep seeing the patients they have, but won’t accept any more,” says Monaco.

“Physicians in general are committed to caring for their patients,” says Rockwood Clinic CEO Dr. Kevin Sweeny, “but as people get older, their need for care gets more complicated and the cost of providing that care goes up.” 

Doctors and hospitals avoided problems the last few years when Congress came to the rescue after the Bush administration proposed cuts in Medicare reimbursements, he says. Each time cuts were on the table — lately in an effort to rein in the rapidly growing federal budget deficit — lawmakers allocated enough money to at least keep payments level or to provide for small increases. And that pattern has carried over into 2008, as Congress has voted to postpone for the first six months a proposed 10 percent cut in reimbursement rates.

Older people — especially imports to Spokane — who have trouble finding doctors can turn to elder care consultant Amber Ford and her colleagues at Honoring Elders.

“We’re the liaison between families and caregivers,” says Ford. They determine what seniors need to stay in their homes or they help them find new living situations. And, if needed, they can help seniors shop for doctors.

“It’s a who-you-know thing,” says Ford. “In some cases we have relationships with doctors and we’ll refer clients to those. Sometimes people are put off by office managers who say they’re not accepting new clients. We try to be professional and a little more insistent and ask [doctors’ offices], ‘Would you consider this new patient?’”

Ford works with families to provide a prospective patient’s records and all the other information physicians consider before taking on new Medicare cases.

“Some doctors are worried about psychosocial issues,” she says. “They want to know if there’s any history of litigation. Will the patient be high maintenance?

“The majority of docs want to help,” Ford continues. “But they have to watch out for themselves. They have a tough job and we’re in a litigious culture. It has made some doctors ultraconservative.”

Janet Monaco says only two of Spokane’s major physicians’ offices are still officially accepting new Medicare patients. Both specialize in training doctors — Family Medicine Spokane and Internal Medicine Residency.

“We have a different economy” than do doctors who need to make a profit, says Dr. Gary Newkirk, the director of Family Medicine Spokane. “We’re a non-profit. We don’t have the same fiscal pressures.” Family Medicine’s mission is to train new doctors. New doctors need patients. “If people don’t mind working with a new doctor, we can provide good care to patients who need to see us,” he says.

Newkirk says his residents see fewer patients than do veteran doctors, which allows them to spend more time with the people they care for and develop relationships.

Family Medicine has seven first-year, seven second-year and seven third-year residents in Spokane, two in Colville and two in Goldendale, Wash. The non-profit is sponsored in Spokane by Sacred Heart and Deaconess Medical Centers.

For now, says Newkirk, the government’s Medicare reimbursement rate is high enough that Family Medicine can break even, but he says additional cuts could force his clinic to do what others have done and close its doors to new patients.

Dr. Kevin Sweeny says Rockwood Clinic has a formal policy that the clinic will no longer accept new Medicare patients. Informally, its doctors may take on a few new clients and new doctors are allowed to enroll Medicare patients for a brief period of time.

Sweeny says the clinic has already decided how it will react on July 1 if the threatened 10 percent Medicare reimbursement cut is enacted.

“That would cost Rockwood Clinic about $2 million in net annual revenue,” says Sweeny. “We will care for our existing Medicare patients and plan to ask staff to minimize overtime. We would reduce our staffing to the minimum that we could. And we’d need our physicians to see two to three more patients a day.”

Janet Monaco doesn’t expect the Medicare doctor shortage to be addressed anytime soon. That means finding a new doctor could be more difficult than ever. What advice does she offer to those who are searching?

“Ask them to write their congressman,” she counsels. 

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