Crisis looms: Medicare coverage doesn't pay enough, doctors refuse service, and Medicare patients can't make up the difference e

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When asked how many doctors offer their services to Medicare patients, Rita Hatch, Medicare Counseling Coordinator at the Older Persons Action Group in Anchorage, just shook her head and said, "It's a sad list.

"We do an ongoing survey of family practice doctors and internal medicine physicians because these are the doctors that seniors generally go to," she said. She keeps the list of providers close to her chest. "I don't publish it and the reason is because I don't want to burn out those doctors on the list," she said. "If someone calls, I'll give them the names of two or three doctors on the list, so they won't all burn out at once."

The State of Alaska Department of Health and Social Services houses the Senior and Disabilities Services (SDS), where anyone can contact the Senior Information Office. Within this office, the staff personnel have access to the Alaska Medicare Claim Administrator's database. More than 3,000 Medicare providers can be found within the State of Alaska. Visit http://www.hss. state.ak.us/dsds/SeniorInfoOffice.htm to look up a health care provider in your area.

THE "NEW" DILEMMA

However, you still have to call each provider to determine if they are taking any new Medicare patients. This published list of statewide doctors, physicians assistants or other health care practitioners are in the Medicare network as Medicare providers, said Essien J. Ukoidemabia, director of the Alaska State Health Insurance Assistance Program (SHIP) and the SMP project (the fraud, waste and abuse side of Medicare) that deals with Medicare.

While Hatch actively looks for doctors who willingly take Medicare clients, she has begun to search elsewhere. "What I've done is found nurse practitioners because there are no doctors, and a nurse practitioner can do anything a doctor can do," she said. "They can send you for tests, refer you to specialists and prescribe medications."

When asked why doctors refuse Medicare recipients, she is succinct.

"Medicare pays too little and doctors charge too much," she sighs. "If they (doctors) would only charge less and Medicare pay more." But Hatch also understands the doctors' frustration with Medicare, particularly its billing method.

BILLING ADDS TO PROBLEM

"If a nurse, when filling out the chart, makes a mistake on the first few things in the billing, then Medicare will kick it back and if they resubmit it with those corrected and there are other mistakes, then they (Medicare) send it back again," Hatch said.

It is obvious to her that the billing process has to be simplified by looking at the entire bill and pointing out the mistakes all at one time so they can all be corrected in order for the doctor to be paid in a timely manner. Being paid promptly would go a long way to encourage doctors to participate in Medicare. Then there is the billing coding which Hatch believes is overly complex.

"There are 10 or more numbers for one procedure," she said. "If they do it with one instrument it is one number, and with another, it's a different number."

All in all, she believes the doctors in Alaska are a pretty honest group. "I don't think there's as much fraud in Alaska as there is elsewhere, it's mostly inadvertent mistakes," she said. But Ukoidemabia looks at this situation from a different perspective.

LOOK OUT FOR FRAUD

"Hatch is one of our best Alaska Medicare Volunteers (she has volunteered with our office since before the current SHIP/SMP director took over in 2004)," Ukoidemabia said. "She is sincere and passionate in her efforts to hold the nation's health care program accountable. She is there at the grassroots level and her experiences with fraud, waste and abuse is relative to the amount of reports that come into her office."

On the other hand, Ukoidemabia said that the Alaska SHIP/SMP receives notices of suspected earnings management abuses and inappropriate practices nationwide, due, in part, to the large group of Alaskan snowbirds (seniors who spend half the year in another state and the second half of the year in Alaska, while remaining Alaskan residents).

Investigations have been initiated with the Inspector General's hotline to report suspected Medicare fraud at 1-800-HHS-TIPS (1-800-447-8477).

"In fact there is a lot of fraud in Alaska, and I get enough calls throughout the year that cause me to have to initiate an investigation, Ukoidemabia said. "The problem is that most of the cases go unreported due to embarrassment of the victim."

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In 2006, Kenai Rep. Mike Chenault successfully introduced a bill that established the Office of Elder Fraud and Assistance, which is one of the programs that Ukoidemabia supports as one of the agency's partners. Anthony Banker is the lead administrator of this agency. This agency functions as a last resort after all avenues or resolutions have been exhausted.

THE FOUR PROGRAMS

Medicare consists of four programs: A, B, C & D. Plan A covers inpatient services, and an individual receives benefits by working and paying taxes and costs 1.45 percent of their income. Part B covers everyone 65 and older (or disabled individuals under 65 who receive Social Security Disability for at least 24 months) for doctor's visits. In 2007, the premium for this service rose to $93 a month. Plan C, the "Advantage Plan," is new just this year to Alaska. It includes dental, vision, and hearing services for some plans. And Plan D, is the controversial drug plan, that now brings the number of Alaska's prescription drug plans to 19, and within those there are 45 options. Warning away seniors from Plan C, Hatch said, "I do not recommend it."

"This plan is run by private companies, and some require referrals to specialists," she said. "Sometimes there's a fee for service--up to $89 a month. Some don't cover dental or physical exams."

The plan is unnecessary if the individual's insurance plan is equal to or better than Medicare, Hatch said. Some doctors even charge as much as a $300 retainer fee to take Medicare patients.

"Just like lawyers," Hatch said. If a senior wants to pay outright what a doctor charges, Hatch warns that some will ask patients to sign a statement stating they are foregoing Medicare.

Again, Ukoidemabia sees the situation from a different perspective. "We in Alaska have only six plans, so I'm suggesting if you can afford the additional premium, then you should apply," Ukoidemabia said of the Advantage Plan. Ukoidemabia further explained that "While administrative policies work to improve these plans, our seniors in Alaska are facing a primary care provider shortage. It seems logical to work with what we have so we can maintain our quality of health. The Medicare Advantage plans offer alternatives to having nothing until the program is fixed. Keep in mind, that our smaller percentage of plans makes it easier to monitor for inappropriate practices. The AARP Advantage plan is coming here next year."

HELP AVAILABLE

Hatch has been a volunteer in her position for the past three years as well as writing a monthly column "News and Views From Rita" in OPAG's statewide newspaper "Senior Voice." To date, OPAG has been unable to secure funding for her position. Even though she's written a guide to Medicare for dummies, Hatch prefers to talk in person with clients because she believes it's easier to explain the procedure. Calls from seniors with questions about Medicare are welcomed. Ukoidemabia also likes to talk as long as needed to straighten out seniors' problems, but she does it on the phone and relies on the network of trained Medicare volunteers to provide the face-to-face counseling in their local areas.

If you call the office, most likely you'll get a recording asking you to leave your name and number, and detail your concern. The federal government funds her position, but she works in a state office. Both would like to see more doctors sign up, but Ukoidemabia said the big problem is there are not enough residency slots allotted to Alaska medical students, so fewer doctors are trained and some do not return to the state.

For instance, Alaska has only 12 residency slots (information garnered from the Feb. 20 hearing held by U.S. Sen. Lisa Murkowski), but Texas has over 100 residency slots. A joint solution begins with not only the federal agencies reconsidering the fee schedule Medicare gives doctors in Alaska given the state's high cost of living and doing business, but also educational and state institutions looking at developing programs to educate and retain more doctors, Ukoidemabia said.

In February, there was a meeting at Loussac Library with Sen. Murkowski to discuss concerns about Medicare in Alaska. People testified, notes were taken and the problems identified, and there is hope that changes will be made.

Helpful Numbers, E-Mails, Addresses and Web Sites

Alaska Medical Assistance Recipient Hotline:

* 1-800-780-9972

To contact someone about the Medicare Drug Plan, call the SeniorCare Senior Information Office for the State of Alaska:

* 1-800-478-6065 (Statewide)

* (907) 269-3680 (Anchorage)

* E-Mail: dsdsmedicareinfo@health.state.ak.us

Providence Hospital Senior Connection Info-Line:

* (907) 269-3225

To contact Rita Hatch at Older Persons Action Group:

* (907) 276-1059

For Medicare help on a federal level 24 hours a day, seven days a week:

* http://www.medicare.gov/pdphome.asp

* 1-800-MEDICARE (1-800-633-4227)

* TTY: 1-877-486-2048

For medical assistance through Social Security:

* http://www.ssa.gov/

* 1-800-772-1213 (Toll free)

* 1-800-325-0778 (TTY for people with hearing problems)

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