Doctors’ Dilemma

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• MARY GARCIA:

  Hi. How are you today?

• TOM BEARDEN:

  Mary Garcia has been taking care of her 83-year- old mother, Catherine, ever since she had a stroke more than 30 years ago.

• MARY GARCIA:

  Hi, mom, beautiful outside today.

• TOM BEARDEN:

  That care-taking became a lot more complicated last November, when her mother's doctor made a fundamental decision about who he would accept in his practice in Fort Collins, Colorado.

• MARY GARCIA:

  We were notified that the primary care physician that she had seen for over 20 years was no longer accepting Medicare and that she needed to find a new doctor.

• TOM BEARDEN:

  Finding a doctor that would take Medicare patients turned out to be an extraordinarily difficult task. Any idea how many doctors you called that day?

• MARY GARCIA:

  Probably 27, 28.

• TOM BEARDEN:

  All rejections?

• MARY GARCIA:

  Every single one was a rejection. They would say no, they're not accepting new Medicare clients, and then you would just keep going down the list.

• TOM BEARDEN:

  Was that frustrating?

• MARY GARCIA:

  Frustrating beyond words. By the end of the day I was practically in tears. I was very concerned that my mom was going to be left without a doctor.

• TOM BEARDEN:

  Garcia eventually connected with Dr. Austin Bailey. Bailey directs the Ft. Collins family medicine residency program, which trains doctors to become family practitioners.

• DR. AUSTIN BAILEY:

  We're noticing an increase in the number of Medicare patients coming to our doors that have attempted two, three, sometimes as many as ten and twelve physicians, seeking physicians, not being able to find one.

• TOM BEARDEN:

  Bailey believes the reason that more family physicians are turning away new Medicare patients is because Medicare reimbursements don't cover the actual costs of treating the elderly. The American Academy of Family Physicians says that nationally, 17 percent of family doctors no longer take new Medicare patients.

  The problem is worse in metro Denver, where the Colorado Department of Insurance says it's 67 percent of primary care physicians. While the government's Centers for Medicare and Medicaid services say that overall access to doctors nationwide remains strong, the family physicians group is worried. It believes more and more and more of their members will opt out of Medicare in the future, because there are more cuts in the pipeline. In addition to the 5.4 percent decrease this year, those cuts could total 17 percent over the next ten years unless the law is changed.

• DR. AUSTIN BAILEY:

  There's a severe ethical dilemma. I watch my colleagues struggle with this all the time as I visit with them about how they are going to handle Medicare patients. They'll tell me, well, Austin, I don't want to take them anymore, I just can't afford to take any more, but then a family member will come in with an aunt or an uncle or grandmother, and say, "please won't you take them?" And so they will.

• DR. CORY CARROLL:

  As much as it pains me to turn away patients, to not accept, new Medicare, to see the need out there, I still have to make money.

• TOM BEARDEN:

  Family practitioner Cory Carroll has a solo practice in Fort Collins. He said he had to stop taking new Medicare patients because he was having to borrow money to meet the payroll for his staff and to pay the rent.

• DR. CORY CARROLL:

  My practice is about 11 percent Medicare. I would estimate if it increased to 25 percent, I couldn't pay the bills. If I can't pay the bills, if I can't pay my staff, I can't practice medicine, and I can't provide for my family.

• TOM BEARDEN:

  The reason doctors are feeling the squeeze now is because the Medicare law ties payments to the strength of the economy. Glenn Hackbarth chairs MEPAC, the Medicare Payment Advisory Commission that advises Congress on how much those payments should be.

• GLENN HACKBARTH, Medicare Advisory Commission:

  The current law was enacted to try to put an overall cap on how much Medicare pays physicians so it says we can afford, as a nation, to spend this much on physician care for Medicare beneficiaries. It links the growth in that amount to the Gross Domestic Product. So if our nation's wealth goes up, we can afford to pay more. If we hit a recession, then we can afford to pay less. That was the concept. Let's put all of this complexity in a box to control spending.

• TOM BEARDEN:

  But Hackbarth points out that while doctors may be facing future cuts because of a slow economy, they also have enjoyed increased payments over the last few years.

• GLENN HACKBARTH:

  In the two years preceding this one, physicians got a large increase, much higher, that the increase in their cost for labor and whatnot.

• DOCTOR TALKING TO PATIENT:

  Are you having much pain at all? Oh, boy, you are sleepy, aren't you? You're going to get me going. Let's take a look at you to see what's making you so sleepy, okay?

• TOM BEARDEN:

  Compounding the problem is that a lot of baby boomers are moving their elderly parents closer to them. Finding those parents new doctors who will take Medicare can be difficult.

• DR. ROGER BERMINGHAM:

  I get calls, I get two to three calls a week from people in our mutual age group who will say, "I am moving my mother, father, uncle to town, and I can't find anyone." So the market's certainly there.

• TOM BEARDEN:

  Dr. Roger Bermingham decided the only way to make it as a family doctor specializing in geriatrics in Fort Collins was to forego an office and staff. He works out of a four-wheel drive pickup truck.

• DR. ROGER BERMINGHAM:

  This is my office, a little unusual compared to most offices – my desk, which has got a file system here; my laptop, which I've got my patient records on. I've got a couple of fishing tackle boxes that I keep one for medical supplies, another for lab stuff like drawing blood, or doing urines or that type of thing, and in the back of the truck I keep spare things, some syringes, gloves, a scale, things like that.

• TOM BEARDEN:

  Bermingham says he really had no choice.

• TOM BEARDEN:

  Medicare did have an impact on your decision to practice out of your vehicle?

• DR. ROGER BERMINGHAM:

  Oh, yeah. Yeah. No question about it. I could not… I would not be able to do this without a markedly decreased overhead. The only way to do it was to cut back on office overhead. The main office overhead are rent, furniture, and personnel.

• TOM BEARDEN:

  Bermingham believes he can provide a better quality of care by seeing people in their own environment.

• DR. ROGER BERMINGHAM:

  I hope I provide a more complete care in that I think I'm able to see aspects of patients and their lives that allow me to get insights into things that may be affecting them in different ways.

• TOM BEARDEN:

  But he's the first to admit that there are downsides. Bermingham can only fit in about two-thirds the number of patients he could see in an office, so he's had to take a cut in pay.

• DR. ROGER BERMINGHAM:

  Let's get a throat culture and then since the odds of her having strep are fairly low…

• TOM BEARDEN:

  He has had to answer as many as 34 phone calls in a day…

• DR. ROGER BERMINGHAM:

  Let's get her some T.K. Antibiotics.

• TOM BEARDEN:

  …And the weather in the foothills of the Rocky Mountains can be a challenge.

• DR. ROGER BERMINGHAM:

  In Colorado, it can be very tenuous as to whether it's going to be very hot in my truck, or very cool in my truck, or both in the same day.

• TOM BEARDEN:

  Bermingham only recently began working out of his truck but is already swamped with new patient referrals.

• DR. ROGER BERMINGHAM:

  Given the aging of America, there's going to be an increased market for it in other communities. I think it takes a special person to do it, but it's not a glory aspect of medicine. Taking care of older, institutionalized patients is to medicine like the Vietnam War is to American military history. It's not something people like to talk about. And it's not particularly a glory filled aspect of the profession.

• TOM BEARDEN:

  But not everyone wants to work like Dr. Bermingham. Dr. Bailey says the Medicare reimbursement problem deeply troubles the residents he trains.

• DR. ROGER BERMINGHAM:

  Talking with the residents about this situation is very, very difficult, particularly in the rural areas where we like our residents to focus on the practice, it's very difficult, because we know that most of the people in rural areas, there's going to be an aging population. We know that their resources are limited, and we know that for many of them, Medicare is going to be the sole payer for their health care. I wish I had an answer to tell them.

• TOM BEARDEN:

  The Medicare Payment Advisory Commission agrees that more and more doctors may opt out of the Medicare program if the projected cuts actually take place. They're asking for a change in

• GLEEN HACKBARTH:

  There is some concern that we're at a tipping point right now as we speak, and that historically good access may have begun to change.

• TOM BEARDEN:

  They're asking for a change in the current law that would increase Medicare costs by $126 billion, but how Congress will react to that big an increase is unclear.