Anchorage Daily News

Alaskans who've paid a lifetime of payroll taxes toward Medicare on a promise they'll receive no-cost health insurance in their retirement years are "frustrated," "resentful" and "really angry" that local family doctors increasingly refuse to accept them as patients.

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That's the message senior citizen advocates delivered to legislators this month at a forum on local Medicare problems.

"We tell people, 'You know, you're probably not going to find a physician, and you should look for a nurse practitioner instead,' " AARP Alaska director Patrick Luby told the Anchorage hearing attended by legislators, doctors and hospital representatives.

Unfortunately, family care doctors have solid reasons for refusing to see patients covered by Medicare, said Dr. Bruce Kiessling, whose practice does not accept it.

Federal reimbursements that are far lower than he normally charges combined with the bureaucracy's "onerous oversight" led him and other doctors at Primary Care Associates -- the largest family practice in Alaska -- to opt out of Medicare in February, Kiessling said.

In its place, they offer a contract to existing patients 65 and older that reduces their fees by 25 percent, he said. Further reductions are offered to patients who can't afford to pay that much. But they do not extend the offer to new patients -- who have to pay 100 percent of the standard fees or seek care somewhere else, Kiessling said.

Primary Care Associates tried the discount once before (during a previous period of opting out of Medicare) and found that 98 percent of their patients chose to stay with them regardless, Kiessling said.

"It worked well," he said, even though some older patients resented losing benefits from a program they'd paid into most of their working lives.

"One could say we had a captive audience that didn't have any other place to go," he said. "But I like to think they had established a relationship with our physicians and wanted to continue it."

Anchorage Rep. Les Gara, who arranged the meeting, asked Kiessling what it would take to get his private medical group and others like it to rejoin the family of Medicare providers.

"I'm at a loss, because we're trying to think of state policies that will enable you to take in more patients in a way that's fair to you and fair to the patients," Gara said.

For example, what if the state offered to pay family doctors a "bonus" if they agreed to treat a certain percentage of older patients on Medicare, Gara asked. "It would help," Kiessling said.

OTHER IDEAS

Other solutions aired during the hearing included proposals to:

• Create an Anchorage "Medicare Clinic" -- an idea now being studied by area hospitals and local physicians;

• Augment the Neighborhood Health Center system, wherein federally funded doctors are legally obligated to treat Medicare patients;

• Grow more family practice doctors in Alaska (to spread the burden of treating the elderly) by expanding the University of Alaska Anchorage/University of Washington Medical School (WWAMI) scholarship program;

• Attract more Outside med-school graduates to Anchorage by offering more residency opportunities, as well as bonuses, to those entering the primary care field;

• Recruit more nurse practitioners, physician assistants and other "mid-level" providers to care for the state's growing elderly population.

"I speak to five or six people a day who are looking for doctors," said Rita Hatch, a volunteer with the Older Persons Action Group in Anchorage.

The only medical providers she can refer them to nowadays are a handful of nurse practitioners in private practice -- or the doctors at the Anchorage Neighborhood Health Center, Hatch said.

"We're pretty much sold on the community health centers," said Luby, the local AARP executive. "We think they're working well. ... They give good service."

Without them, local hospital emergency rooms, which are required to take patients regardless of their ability to pay, would be swamped with those seeking routine care, Luby said.

THE $900 VISIT

Representatives from Alaska Regional Hospital and Providence Alaska Medical Center said Medicare patients without providers already frequent the local ERs.

"We have to see them," said Laurie Herman, a consultant at Providence. "Then what was a primary care visit becomes a $900 emergency visit."

That same scenario has local physicians and hospital administrators exploring the creation of a clinic that would treat Medicare patients exclusively, said Sharon Purkis, an administrator at Regional Hospital.

What's currently being considered would probably involve a cadre of nurse practitioners overseen by doctors, she said. A request for proposals for business plans was issued this month.

Employing more mid-level providers, including physician assistants, has become a business imperative at clinics that struggle for dollars, said Dr. Peter Mjos, a staff physician at the Anchorage Neighborhood Health Center.

"That's the future," said Mjos.

Med-school students these days are choosing to enter specialties that promise regular hours and higher pay -- "seven-figure incomes" -- rather than suffer the round-the-clock life of a family physician, Mjos said.

Could those same students be enticed into careers as general practitioners if the federal government helped make it worthwhile?

Maybe they could, Gara said. It's possible that long-term solutions will eventually come from Washington. But in the short-term, it's becoming increasingly urgent for Alaska to address the problem too.

"Not many states have had anywhere near as much medical problems as we have up here," said Luby.

Find George Bryson online at adn.com/contact/gbryson or call 257-4318.