In South Anchorage, a new kind of medical center is trying to make it financially based on payments from Medicare -- the federal health insurance for people 65 and older, that many doctors shun.
Most primary care doctors in Anchorage won't take new Medicare patients because they say the reimbursement rates are set too low, and they lose money.
But at the recently opened Alaska Medicare Clinic, on the Old Seward Highway near O'Malley Road, you have to have a Medicare card to get in. Or be nearly old enough to get one.
The clinic intends to hold down costs by relying on teams of registered nurses and medical aides to spend more time with patients, reserving final decisions for the one doctor, Dr. Bob Thomas. When the clinic is at capacity, the idea is Dr. Thomas will see 45 patients a day -- at least double the number most primary care doctors see.
"It's this way of doing things that we think will allow the clinic to work on Medicare," said Dr. George Rhyneer, a retired cardiologist who spearheaded creation of the clinic. The clinic is a nonprofit organization.
The Alaska Medicare Clinic is the second clinic for Medicare patients to open this year in Anchorage. The other, Providence Senior Care Center, started up in January and takes patients 55 years old and older. The Providence clinic has a two-month waiting list for first-time patients, but is still accepting new patients.
The Alaska Medicare Clinic opened in May, has plenty of room still and can offer next-day appointments, said Rhyneer.
Addition of these two clinics means that for the first time in about a dozen years, people on Medicare should have no trouble finding a primary care doctor in Anchorage.
The Anchorage Neighborhood Health Clinic in Fairview accepts all patients, including those on Medicare.
"There are three clinics now I can send them to. That's great. It's much better than it was," said Rita Hatch, a Medicare specialist at the Older Persons Action Group who keeps track of which doctors take Medicare patients.
Hatch started surveying doctors on Medicare 14 years ago. "It was OK for a couple of years then all of a sudden it crashed," she said.
Some doctors allow Medicare patients to stay if they agree to not use Medicare, and pay their own doctor bills. That appears to be a growing practice, said Mark Foster, a health care analyst and consultant to the University of Alaska Anchorage's Institute of Social and Economic Research.
Some don't accept them at all, and others, such as those at Medical Park Family Care, allow younger patients who age into Medicare to stay with the clinic, but don't take new Medicare patients.
It's a hard decision, said Dr. Timothy Laufer of Medical Park Family Care. His clinic voted three times to opt out of accepting Medicare because of low reimbursement rates and too much paperwork, but then changed their minds, he said.
Of an estimated 26,000 Medicare patients in Anchorage, Foster said probably 8,000 to 10,000 of them still don't have primary care doctors. He predicts the two new Medicare clinics will fill up and both have waiting lists in a year or two.
The two new Medicare clinics in Anchorage each got financial help to get under way. Providence is subsidizing its Senior Care Center, and the Alaska Medicare Clinic received $1 million in start-up money from the state Legislature.
But the goal of the Alaska Medicare Clinic is to make it on its own. "There's lots of room for more patients," said Dr. Rhyneer. "We know we'll break even when we get to the target load."
HIGH LEVEL NURSES
It's an untested model. Rhyneer said he hasn't heard of anyone else trying just such a method, relying on high volume for a single doctor.
Here's how it works:
There are three teams consisting of a registered nurse and a medical assistant; each team uses three exam rooms, for a total of nine.
In the first step, the assistant checks the patient's height, weight, blood pressure and other vital signs, any allergies and medicines the person is taking.
Next, an RN -- a highly paid, top-level nurse, like those more often found in hospitals than doctors' offices -- gets a detailed medical history, and finds out what's going on with the patient that brought him or her to the office, and answers questions.
Then Dr. Thomas comes in, and the nurse concisely explains the situation to the doctor. He does his own exam. The nurse documents it and follows up.
The system allows both the nurse and the doctor to operate at the top level of their professions, Rhyneer said.
"The best part of the job is it allows the nurse to work at full capacity," said Becky Bole, one of the RNs. The nurses are trained to do patient histories and physical exams, check out symptoms, and give input into the plan of care, said Bole. "It's something brand new."
SATISIFIED PATIENTSAnother aspect of the Alaska Medicare Clinic's system is to prioritize patient medical concerns , and only deal with the most urgent in one visit.
"You might start with heart failure and blood pressure right away, and have them come back in a week. Then you'd check on those and also on the diabetes," said Rhyneer.
So far, a sampling of patients interviewed say the Alaska Medicare Clinic team system is working well for them.
Lawrence McMahon, who turns 70 in December, said he hasn't paid much attention to medical care in recent years, but had a headache scare that resulted in an emergency room visit.
The ER doctor recommended he go the Medicare Clinic for a check-up. "I went over there and got treated like a king," said McMahon.
Kay Haneline, 67, said she and her husband were both dumped by the clinic they had been going to when they hit 65. They could have stayed and paid cash at their old clinic, but then couldn't have used their Medicare or secondary insurance.
"The whole experience was distasteful," she said. "I called over 30 different doctors and none of them would take us."
Her husband finally found a doctor in Eagle River.
She's now a patient at the Alaska Medicare Clinic, and said, "I liked it all. I talked to the nurse 15 or 20 minutes. Then the doctor came in. I liked his attitude. He seemed knowledgeable and he listened. ... I'm very glad that they're here."
Both the Providence Senior Care Center and the Alaska Medicare Clinic plan to add to their patient loads.
Alaska Medicare Clinic has about 500 patients so far, and is aiming for 4,000, said Kirsten Gurley, the clinic manager.
Providence Senior Care has served about 1,300 patients as of the first of August, with four doctors and an advanced nurse practitioner. They plan to add two doctors by the end of the year, which will cut down the waiting list time -- at least for now.
Reach Rosemary Shinohara at firstname.lastname@example.org or 257-4340.