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Seniors hunt for doctors

By MARINA PARR

Contributing writer

The seniors enrolled in Medicare in Washington state are less likely to visit a doctor, are apt to spend far fewer days in the hospital and are generally healthier than their East Coast counterparts.

It all sounds pretty positive. But not in the topsy-turvy world of government programs.

The relative thrift and health of the elderly population found in Washington, and across the West Coast, has cost this region of the country in reimbursement rates.

What it boils down to is this: A doctor practicing in Coupeville will receive a smaller federal check to set a broken leg than a doctor in Miami.

The reason? In general, seniors cost less to treat on the West Coast than on the East.

Some say that’s because of efficiencies. West Coast seniors are less likely to undergo expensive procedures and tests. In the past, they also were more likely to be part of a managed health plan that kept costs in check.

This inequality in reimbursement rates — much of it rooted in 30-year-old data — has some physicians calling foul. Others tire of complaining and move to states with better rates.

On Whidbey Island, the Medicare problem is compounded yet again because of the island’s rural setting. Not only does Washington state receive less federal Medicare money per patient than say, New York, but rural places receive even less of it than urban ones.

For instance a typical office visit is reimbursed at $40.29 in King County. For Island County and the rest of Washington state it sits at $37.40, according to the state Department of Health’s Office of Community and Rural Health.

Meanwhile, in San Francisco, doctors get $48.21 for the same visit.

Congress has pushed to narrow the reimbursement gap in recent years and the difference is less glaring these days than it was even four or five years ago.

“There are still some disparities but not as big as they used to be,” said Vince Schueler of the state’s Community and Rural Health office.

A study conducted by the Washington State Medical-Education and Research Foundation showed Washington ranking 42nd among the states in Medicare spending per patient. But the figures used in the study were based on 1998 rates.

These days it appears the state is far closer to the middle of the pack in per-patient spending, according to Schueler. Getting an accurate figure is difficult because the data are not reported by where the beneficiary lives, but where a managed health care plan happens to be headquartered. (In some cases one plan serves several states.) In other words, often there is no service-for-service cost comparison available.

But when looking at just one procedure — in this case a typical office visit — the city of Seattle does fairly well. In fact, the city rated 24th out of 93 areas carved up across the country by the federal government. The rest of the state ranked 50th, or a little bit less than average for reimbursement for an office visit.

The federal government also pays doctors a fixed amount of dollars per patient through managed care plans. These plans, also known as HMOs, are prevalent in larger, urban areas. A doctor in most places in the country, including Washington state, receives between $540 and $600 per person, per year.

But in some places the gap is much wider. For instance, a Long Island, N.Y. physician receives $870 per year for providing the same services.

A more pressing issue for places like Whidbey Island is the unequal number of dollars that flow to urban and rural areas. Rural areas continue to come up short, just as Washington state’s Medicare reimbursement rates tend to lag behind East Coast states, as a whole.

Senator Patty Murray, D-Wash., has tried to fix both problems.

Last year, Murray pushed a bill dubbed MediFair that would have lifted all below-average states to the national average. The intention was to help lesser-funded states get their hands on more Medicare money while not harming those who already do.

Her bill also would have rewarded states where doctors appear to be more efficient, resulting in healthier patients who require less expensive treatment.

Murray’s bill did not make it through Congress last year and she will reintroduce it in the coming months.

In the meantime, Murray helped craft a section of a prescription drug bill that will increase the amount rural hospitals receive relative to urban ones. She also succeeded in passing another amendment to the prescription drug bill that will give Washington state a boost when calculating the cost of treating ailing seniors. Now the federal government will need to include Washington residents treated at military and veteran’s hospitals, a significant chunk of the population in a state with multiple military bases.

Fixing Medicare is proving to be a slow process, in part because the system is so complex, and also because changing the ways states are reimbursed is inherently political and sure to include plenty of turf wars.

“If you increase reimbursement for one area then you have to decrease it somewhere else,” Schueler said. “The places that have the really high reimbursement rates have senators with a fair amount of seniority. It’s politically difficult to take stuff away from folks ... Basically it involves some very difficult choices about who gets what.”

For now, doctors in this state are making do with less money. They also are more apt to retire early or close their practices to new Medicare patients.

Even if Washington’s reimbursement rates were brought up to the national average it still doesn’t ensure doctors would receive enough money to cover the costs of treating ailing seniors.

“Are we paid better or worse than other parts of the country? That’s one question. The other question is are doctors being paid enough to cover their costs and that’s another question entirely,” Schueler said.

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