More Medicare patients being refused

Over the last two months, Patricia Trigiani has called the offices of four primary care doctors in an effort to become established as a regular patient. All have turned her down.

Trigiani, 67, who recently moved from San Diego to Niantic, is covered by Medicare and a supplemental Blue Cross/Blue Shield policy, but all four offices she contacted are refusing new Medicare patients.

"That's discrimination, as far as I can see," said Trigiani, a retired laboratory technician who moved back to southeastern Connecticut, where she grew up, to be near her family. "Now I'm still searching."

According to a recent survey by the Connecticut State Medical Society, Trigiani's experience is becoming more common. Of 354 physicians who responded to the survey that was released Jan. 18, 19 percent said they either have begun limiting appointments for patients covered by Medicare and TRICARE, the insurance for military families, or have begun declining new patients with either type of coverage.

The survey's main purpose was to gauge the impact of a scheduled 27 percent cut in Medicare and TRICARE rates paid to physicians that is scheduled to take effect at the end of February unless Congress passes legislation to prevent it. According to the survey, 72 percent of responding doctors said the cut would force them to change the way they provide access to Medicare and TRICARE patients.

But growing frustration over the pending rate cut, which has been threatened and delayed numerous times since the 1996 Sustainable Growth Rate law adopting it was passed, has motivated some doctors to decide they've had enough.

"For those of us in primary care who provide high-volume, low-cost care, it's crazy," said Dr. Peter Gates, a primary care doctor in the region for 25 years who now practices in New London.

Gates and his partner, Dr. Gary Bertman, decided last fall that they would not accept new Medicare patients. They still treat Medicare patients on their roster, as well as established patients who age into Medicare. About 60 percent of the patients they treat are covered by Medicare.

Gates said his office gets calls "every day" from Medicare recipients looking for a doctor, and that saying "no" wasn't an easy decision. "You hate to exclude one group," he said.

But the prolonged uncertainty about reimbursement rates, coupled with other recurring bureaucratic hassles with Medicare, takes too much staff time and resources away from his independent practice that could be put elsewhere, Gates said.

Citing one example of impractical Medicare policies, Gates said he recently had to stop making house calls to homebound Medicare patients, something he would do for just one or two patients a month. House visits were the best way to see certain patients, such as those with end-stage cancer, but due to a recent rule change Medicare only allows him to bill for office visits, he said.

For many of the same reasons as those cited by Gates, Dr. Steven Johnson and the other three physicians in the New London Family Practice also stopped taking new Medicare patients last year.

"This rigmarole (with the Sustainable Growth Rate) has been going on for 10 years, and we got fed up and this was the only statement we could make," said Johnson, who still treats the Medicare patients who were already in the practice, which comes to about 30 percent of its total patients.

But Johnson said he didn't want to take on new patients only to have to tell them to find a new doctor if the rate cut took effect because the cost of providing the care would not be covered by the new rate. Some of those his practice is declining are the husbands, wives or mothers of current patients, and that is particularly difficult, he said.

"I don't know of anyone taking new Medicare patients," Johnson said. "There aren't many primary care doctors to begin with, and we're in demand."

While the ranks of doctors willing to accept new Medicare patients has become more noticeable over the last year, the thinning apparently began over the last several years. Susan Roberts, a 69-year-old Lyme resident, said she was turned down by a doctor four years ago, when she first became eligible for Medicare.

"It was so shocking to me to be told that," she said. "It was a real slap in the face."

Ultimately, Roberts said, she found a doctor willing to take her on as a patient when a friend who had been a specialist became a primary care doctor.

U.S. Rep. Joe Courtney, D-2nd District, raised the issue of the need for Congress to address the Medicare rate issue during testimony this week. A conference committee has been given a Feb. 17 deadline for finding either a permanent fix or delaying the scheduled cut for two years while a long-term solution is developed.

Courtney said he is particularly concerned about the Connecticut Medical Society survey's findings about curtailed access to doctors for Medicare patients, and he conveyed that in his remarks to fellow congressmen.

"This is not an issue we can wait on," Courtney said Friday. "It's changing behavior already."

j.benson@theday.com