Published January 2003

No new Medicare patients for Medalia

By Sharon Salyer
Herald Writer

Effective Dec. 2, Medalia Medical Group stopped accepting new Medicare patients, just part of the local fallout from a second straight year of federal cuts in what doctors get paid to see these patients.

It’s not the only bad news for Medicare patients.

Group Health said that it hoped to lift a two-year ban on accepting new Medicare patients in Snohomish County this year, but will not be able to do so.

And the Everett Clinic, which in November disclosed that like Medalia it might also have to bar new Medicare patients, will soon make its decision on the matter.

“I wish there was some other way we could get around this,” Dr. Earl Beegle, Medalia’s chief medical officer, said of the ban on new Medicare patients.

“This is a government-run program,” he said. “And if the program is not funded appropriately to the point that (doctors) can afford to pay their costs, there comes a point where it can no longer be tolerated and stay in business.”

Medalia took the action after Congress failed to roll back a scheduled 4.4 percent federal cut in what doctors will be paid to care for Medicare patients this year during its recent lame-duck session.

Medical clinics took a 5.6 percent cut in reimbursements in 2002. The Everett Clinic estimates it lost $800,000 because of the cut.

The cuts are compounded by the fact that clinics already were losing money on each patient, Beegle and representatives of other area medical clinics said.

Since Medicare patients are at least 65 years of age and often have multiple medical problems, they typically need a longer office visit than someone seeing the doctor for a single problem, such as an earache or sore throat, Beegle said.

So while the clinics generally charge $126 for an extended office visit lasting up to 30 minutes, Medicare pays only $77, Beegle said.

Beegle emphasized that Medalia’s decision on new Medicare patients does not affect existing Medicare patients, or current patients cared for under private insurance plans who are turning 65 and will soon enroll in Medicare.

However, it will affect anyone who is now on Medicare and wishes to change medical clinics or anyone who is new to the area.

Kathie Harris, director of Medicare programs for Group Health, said the co-op had originally hoped to accept at least a few new Medicare patients in Snohomish County this year.

“We just were not able to do that,” she said, adding that in addition to federal payment issues, Group Health did not have enough doctors to treat additional Medicare patients at its Everett Medical Center.

The organization treats 2,800 Medicare patients in Snohomish County.

Current patients about to turn 65 will not be affected by Group Health’s continuing ban on new Medicare patients in the county.

Rick Cooper, chief executive of The Everett Clinic, said his organization may have to limit new Medicare enrollment because it expects to lose up to $14 on each visit by a Medicare patient this year. Total losses to the organization from treating Medicare patients is expected to be $1.1 million, he said.

Beegle and Cooper both said they expect other area clinics will follow Medalia’s decision to cut off new Medicare patients.

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