Seniors hunt for doctors

Gale Sims may not realize it just yet but in the next few years she’ll join a growing group in which she may not want to be a member.

Right now, at 63, she qualifies for financial assistance at the North Whidbey Community Clinic in Oak Harbor, where she recently received a check-up. When Sims turns 65 two years from now she will be eligible for Medicare, the nation’s medical insurance program for seniors and the disabled.

But will there be a doctor available on Whidbey Island to see her?

“I’m going to keep on with him,” said Sims, looking over her shoulder at Dr. Haigh Fox, who had a stethoscope pressed to her back.

In Sims’ case the prognosis for finding a health care provider may be better than for others new to Medicare. She is already an established patient.

But for many seniors who rely on federal health insurance, an increasing number of doctor’s offices are closed. That’s because doctors say government reimbursement rates are so low that they can treat only a limited number of Medicare clients before they begin bleeding red ink.

“They’re doing it out of social obligation and because they follow people for years and they’re not willing to abandon them,” said Dr. Fox, who also works part-time out of the South Whidbey Community Clinic in Clinton.

Still, there is room for optimism. Two primary care doctors recruited by Whidbey General Hospital in recent months say they are open to new Medicare patients. And the hospital’s two community clinics, helped by grant money, also welcome those who rely on the federally funded health insurance program.

But as Whidbey Island’s population continues to gray, mirroring the national trends, the question of who will treat seniors becomes more pressing.

Already, the island has witnessed the departure of several primary care physicians who have left, in part, because the financial picture is so gloomy.

To stem this flow, and perhaps reverse it, Whidbey General Hospital hired a recruitment specialist six months ago. (See related story.)

Right now, the hospital runs the north and south end community clinics to help serve low-income patients, including Medicare clients. The hospital hired Dr. Fox to oversee the clinics in 1999. Much of the work is done by nurse practitioners or physician assistants. That helps keep costs down, because mid-level medical specialists are paid less than doctors. Also, because the clinics pull in grant money, they are better able to keep afloat financially despite lagging reimbursement rates.

New doctors in Oak Harbor

The hospital also was successful in recruiting two new primary care doctors who will be taking new Medicare patients at Oak Harbor Internal Medicine, at 1049 S.W. City Beach Street. They are Dr. Jennifer LeTourneau, who started this week, and Dr. Elhami Hannan, set to begin in September.

“I think that’s very important to people on Whidbey Island,” said Whidbey General CEO Scott Rhine. “One of the biggest concerns we hear is that people moving to the island or converting to Medicare find it difficult to find physicians willing to take on additional Medicare patients.”

Both LaTourneau and Hannan also will likely see patients from the south end of the island — spending some portions of their week at a Freeland doctor’s office, Rhine said.

Doctors at Whidbey Community Physicians also are accepting new Medicare patients at both their Oak Harbor and Freeland offices, although they are reluctant to advertise it.

“Any Medicare patient who walks through that door, I lose,” explained Dr. Chris Bibby, who works out of the 10-physician family-care practice in Oak Harbor. “They bring about 55 cents on the dollar and I need 68 cents just to break even.”

Bibby said he sees the situation worsening, as Whidbey Island becomes a destination place for gray-haired retirees.

Regardless of whether a patient has supplemental insurance, doctors who treat patients 65 and older are paid Medicare rates. That means that although a patient with private insurance may pay a lower deductible for a procedure, the doctor gets only the federally-approved amount.

“You could be Bill Gates and you will be given the discounted Medicare service rate even though you’re a multibillionaire,” Bibby said. “I can’t accept any different than Medicare rates. I have Medicare patients coming in and saying ‘I will pay the difference.’ But I can’t accept that or I will go to jail. Your hands are tied.”

Meanwhile, doctors are getting less these days from younger patients with private insurance policies. Those patients are needed to balance out the losses doctors face from Medicare. But insurance companies are ratcheting down what they will pay for a procedure, bringing rates more in line with what the federal government is willing to pay.

At the same time, the cost of prescription drugs are rising and expensive life-saving treatments are becoming more routine. In other words, the cost of American health care is skyrocketing, and so far it’s not clear whether there will be the money to pay for it.

All Bibby and his fellow physicians know is that, for now, they appear to be on the short end of the stick. If you tried to go to a grocery store and bought $100 worth of groceries but only gave the cashier $55 to pay for them the store would kick you out, Bibby said.

Doctors, trained to help people and save lives, are far more reluctant to shut their doors, even when low-paying patients eats at their practice’s bottom line. Recently, physicians in other states have gone on walk-outs over such big-ticket issues as the cost of malpractice insurance.

But for the most part, physicians have complained from the sidelines and little has been done to make sure they are adequately paid for what they do.

“We’ve been preyed upon because of that,” Bibby said. “Doctors are not going to kick their patients out. We have been very bad businessmen in that respect.”

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