Providence plans to open clinic for seniors

PROVIDENCE ALASKA: Officials hope facility will slow local Medicare crisis.

June 4, 2010 

Providence Alaska Medical Center, wanting to tackle Anchorage's Medicare crisis, plans to open a clinic for senior citizens, Providence officials say.

The clinic will target people older than 55 -- including Medicare patients, who face a shortage of primary care doctors willing to take them on. Local doctors say Medicare, the federal insurance for those 65 and older, doesn't pay them enough to cover costs.

The clinic is expected to open early next year in one of Providence's existing buildings, and will get a subsidy of several hundred thousand dollars per year from Providence, said Dr. Tom Hunt, the hospital's executive director of physician services.

He is in charge of it.

For years, Medicare patients in Anchorage and other parts of urban Alaska have struggled to find primary care doctors.

A new report from the Institute for Social and Economic Research at the University of Alaska Anchorage says the problem is worsening -- more local primary care doctors than before are declining to participate in Medicare. At the same time, the large baby-boom generation is about to reach Medicare age.

Hunt estimated 26,000 people in Anchorage are on Medicare, and said probably 13,000 of them don't have regular primary care providers.

The Providence Senior Care Center will be able to serve about 3,000 individual patients the first year, he said.

Providence is also participating in two other initiatives to provide care for several thousand more senior citizens:

• The hospital will give about $250,000 annually for the next few years to Anchorage Neighborhood Health Center, a community health clinic that receives federal money and is mandated to care for under-served groups. The money will go toward increased senior care, said Hunt.

• Providence will donate in-kind services to a proposed Medicare clinic spearheaded by a retired Anchorage cardiologist, Dr. George Rhyneer. That clinic, which will receive $1 million from the state, is designed for efficiency, with nurses and other staff besides doctors providing much of the care.

A TEAM FOR EACH PATIENT

Providence's push to expand service for Medicare patients came from the hospital's board of directors and the board of the Providence Foundation, said Hunt.

"Both felt that Prov needed to make Medicare access a top priority this year," he said.

The Providence clinic will be set up as what is called a patient-centered medical home -- an approach in which a team of people such as a nurse, doctor and case manager provide comprehensive care for each patient. The case manager, for example, would follow-up with the patient between visits.

Southcentral Foundation serves Alaska Natives in Anchorage using the same model. Southcentral claims success in improved health for its patients and reduced costs using this approach.

The model is gaining in popularity around the country, and is promoted in the new federal health care reform law.

Hunt said Premera and Boeing set up such a clinic in Washington state for Boeing's most complex patients, "and saved a ton of money."

ROOM FOR TWO CLINICS

Hunt sees Providence as serving patients with multiple medical problems, while Rhyneer's Medicare clinic serves less complex cases.

Rhyneer said his clinic could see complex patients, too, but the patient would need to make more than one visit to get the problems dealt with. No one knows how many patients a clinic tailored to Medicare rules can handle, but it could be up to 6,000 a year, he said.

"The real difference is the clinic I've been working on is going to provide what Medicare pays for. It will not be subsidized by any organization," Rhyneer said.

Medicare doesn't pay for things like doctors handling phone calls from patients, extensive counselling, or very much physician time, he said.

There's little doubt that there are enough Medicare patients for both clinics and more. But Rhyneer is worried about finding doctors and nurses for his clinic in competition with Providence.

He said for that reason, he was disappointed to learn that the Providence clinic will be getting organized around the same time as his.

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