Our view: Medicare opportunity

This could be very good news for thousands of Medicare patients suffering a doctor shortage, long waits for appointments at the Anchorage Neighborhood Health Center or last-resort trips to the emergency room.

That could be very good news for thousands more Medicare patients expected to call Anchorage and the Mat-Su home by 2014, when the population of those 65 and older is expected to rise from 26,000 to 36,000.

Rhyneer and backers of the proposed clinic have raised $200,000 in private donations and are seeking $500,000 in federal funds and about $1 million in state money to start the clinic. They expect it to be self-sustaining after startup costs.

They won't build from scratch but aim to find office space suitable to refit for medical practice somewhere between Providence Alaska Medical Center and Alaska Regional Hospital. Staff would number seven, with an experienced doctor, nurse practitioners or physicians assistants, receptionist and billing clerk.

Patients wouldn't always see the doctor. Where mid-level care would suffice, that's what patients would get with a nurse, nurse practitioner or medical assistant. The model calls for the doctor to see an average of 35 patients per day and for the mid-level staff to see 70. That's a lot.

That's also why the clinic can work even given low rates of Medicare reimbursement -- efficiency of service and a practice narrowed to older patients with uncomplicated billing requirements should yield an economical operation and one that can afford to pay competitive salaries to its staff.

Staff is key, because success will depend on experienced, able and dedicated people. Dr. Rhyneer envisions seasoned professionals working at "the height of their competence" to build a clinic that operates at high efficiency but retains the comfort of a family practice. He wants salaries sufficient so that good health professionals won't feel they're making a sacrifice. Instead, they may have a chance to make Alaska health care history.

Dr. Rhyneer has no illusions that the clinic will be born whole. He expects a startup period of tweaks and adjustments as medical professionals change some of the ways they've operated. He sees three critical points: • First, find a good administrator to get the clinic up and running, from remodeling and equipment to vetting and hiring the first doctor.

• Find an experienced doctor who can be both physician and administrator. Ideally, the administrator position would go away when the clinic came up to speed.

• Buy or build an electronic medical records system that will save time and connect with other medical offices and hospitals. This is vital for cost control and will take $600,000 of $1.7 million in startup money.

This Medicare project is ambitious, economical and realistic. Dr. Rhyneer and other backers have the support of Republican legislative leaders Sen. Kevin Meyer and Reps. Bill Stoltze and Mike Hawker. AARP is on board. Dr. Rhyneer said last week that even without federal money, the clinic can get started if the state comes through.

Sens. Lisa Murkowski and Mark Begich and Rep. Don Young should push hard in D.C. -- they can argue that this is a $500,000 contribution to health care reform that promises to both control costs and increase access. For the state's part, $1 million is a small investment for the potential payoff of providing dependable, self-sustaining health care for thousands of Southcentral Alaska seniors -- starting this year.

Let's not delay.

BOTTOM LINE: Medicare clinic is a good idea that deserves state and federal backing.