Help is arriving for thousands of seniors in Anchorage who are going without primary care doctors because the doctors don't accept Medicare, the federal insurance for people age 65 and older.
Providence Alaska Medical Center recently opened a doctors' office for patients age 55 and older. Providence hopes its Senior Care Center, starting slowly with 200-plus clients so far, will eventually serve 5,000 to 6,000 of the estimated 13,000 seniors on Medicare in Anchorage who don't have primary care health providers.
Medicare is welcome at this clinic.
Some patients said they feel welcome too, and not rushed. "It just blew our minds," said Michael Carson, 73, a retired elementary school teacher. "The doctor had time to talk to you."
Another patient discovered the clinic just as she ended breast cancer treatment, which was all handled by specialists. They kept asking, who's your primary doctor? And she didn't have one, said Sharon LeDoux.
Outside of public health clinics, few primary care doctors in Anchorage will accept new Medicare patients because federal payment rates are too low to cover their pay and overhead, the doctors say. Some doctors keep existing patients who reach Medicare age, but others tell 65-year-olds they'll have to pay cash or find another doctor.
Rita Hatch, a volunteer for the Older Person's Action Group, said she used to refer seniors to advanced nurse-practitioners for primary care, but now most of them are filled up, too. Compounding the Medicare money problem is that many older patients have multiple health conditions that take more time to treat.
The Providence board of directors and the board of the Providence Foundation decided to dive in and see what they could do.
A retired cardiologist, Dr. George Rhyneer, has start-up money from the state, and is also hoping to open another Medicare clinic soon. Rhyneer plans a streamlined clinic designed for efficiency, with nurses and other staff providing much of the care, but every patient seeing a doctor, too. He has a building on O'Malley Road. But he's been recruiting for an experienced doctor since fall, and so far hasn't found one, he said.
Primary care doctors are in high demand. There's a national shortage.
Anchorage Neighborhood Health Center, a community clinic in Fairview, also takes Medicare patients. It receives federal money and is mandated to offer care to under-served groups.
The number of Medicare patients the center sees rose almost 1,000 people from 2009 to 2010, said Joan Fisher, the center's executive director. Anchorage Neighborhood Health is building a new, larger center, but Fisher said all of these initiatives are needed and more to serve the state's growing senior population. She pointed to a state report that shows the Alaska senior population increasing by about 7 percent a year.
The Providence clinic has some advantages for attracting doctors. It offers pay based on salaries with productivity incentives; doctors don't have to worry about losing money by taking on Medicare patients. The hospital is subsidizing the clinic, expecting to contribute $400,000 this year and about $250,000 next year.
PATIENTS GET AN HOUR WITH DOCTOR
The Providence clinic will be a "medical home" that will coordinate all the health needs of its patients, from managing medications to communicating with specialists like cardiologists and surgeons, said Dr. Tom Hunt, the hospital's executive director of physician services. He organized the senior clinic.
They're adding patients gradually so as to have an hour to get to know each new patient and their health conditions, he said. They have a registered nurse -- rare in private doctor offices because of the expense -- who will check patients' medicines, make sure the right information gets to and from other doctors, talk to patients. "Grease the wheels," said Hunt.
So far there are two doctors in the Providence Senior Care Center: Dr. Peter Mjos, a former Anchorage Neighborhood Health Center physician who came out of retirement for this, and Dr. Catherine Schumacher, who has been a state epidemiologist, worked for the Alaska Native Medical Center and the Alaska Tribal Health Consortium, and most recently was in private practice with the Anchorage Medical and Surgical Clinic. Kiki Green, an advanced nurse practitioner, has also joined the clinic.
Providence is trying to hire more providers. By the time they get seven doctors, nurse practitioners and physician's assistants, they should come close to breaking even, said Hunt.
SOME FEEL REJECTION
Mjos walked around the freshly painted clinic one day recently, pointing to computers set up in patient rooms so that he can look at the patients and still refer to electronic records the clinic is using -- old-fashioned face-to-face time, and the latest in technology, too.
Most of his patients have complicated medical histories, he said. "Many are chagrined that they were dismissed by their previous provider."
The clinic, which opened Jan. 24, made it a priority to get Medicare patients without primary care doctors in first.
Carson and his wife, Ruth, were there last week. Ruth Carson, 83, had been seeing the same doctor for some 60 years, since she came to Anchorage in 1948, and Michael, 73, had been seeing that doctor for 40 years. About a year ago, the office where their then-elderly doctor practiced said they couldn't see Medicare patients anymore.
"Not to have access to a general practitioner other than going to the emergency room, it was just a great inconvenience and a concern," said Michael Carson.
"I'm so relieved and so grateful for the kind of care we were getting at Providence," said Ruth Carson. "It wasn't like we were intruding. It was OK for us to be there."
Reach Rosemary Shinohara at firstname.lastname@example.org or 257-4340.