ABC11 Investigates

Doctors who take Medicare scarce

Thursday, May 10, 2012

Beverly Frake moved to the Triangle two years ago from upstate New York.

"Northern winters were getting to me just a little bit," she explained. "My daughter was here, and she really liked it. She wanted me to come down."

But, she had no idea that when she became a Triangle transplant that she would be waiting to find a new doctor.

"I moved into this nice apartment complex, big medical complex across the street, I thought, 'How lucky am I?' And I went there and was told in the waiting room, well, they just didn't take Medicare patients," Frake recalled. "One of the receptionists said to me, 'Well honey, it's just going to get worse.'"

ABC11 assembled a team of volunteers with the help of the AARP to be "secret shoppers" looking for a new doctor. We discovered it can be very difficult for Triangle transplants and people aging up into Medicare eligibility to find one.

"It affects everyone. It's a nonpartisan issue because we all face the issue of growing older, dealing with the issues that our parents go through," offered AARP State Director Doug Dickerson.

We had our volunteers randomly call family physicians using a list from the North Carolina Medical Society. Our volunteers found nearly 50 percent of the 200 doctors they called are not taking new Medicare patients.

"I have had many friends who have moved down here to retire and they cannot find a physician to take them," said volunteer Mary Kay Corr. "It's very sad, because they are coming down here to start a new life, a lot coming to be closer to families, and they have medical problems. Unfortunately, they're finding that no one wants to take them. This is a very serious problem to say the least."

In call after call, our secret shoppers discovered that a government program they paid into, and were promised would be there for them, can lead to broken promises.

"I'm surprised that in the Raleigh area there's so many people not accepting," said volunteer Denny Hoadaley.

"I've experienced it myself, especially amongst specialists. They just don't feel like they're being reimbursed enough money to make it worthwhile," said volunteer Billy Smith.

The I-Team also discovered that some doctors who are accepting new Medicare patients make the patient pay the doctor out of their own pocket, and then be reimbursed by Medicare themselves.

"Makes it more difficult, more paperwork. Obviously, elderly people do not have much experience with all that paperwork. Our chances of making a mistake and not collecting are pretty good," said Hoadaley.

We took the findings of our secret shopper investigation to the federal agency in charge of Medicare. The Center for Medicare Services told us it's surprised so many doctors are refusing to take Medicare patients here in the Triangle.

The agency was planning its own secret shopper investigation like ours, but it pulled the plug after getting pushback from doctors.

Dr. Joseph Shanahan was up front with the I-Team about the challenges of accepting Medicare patients.

"I don't do medicine for the money. I never got into it to get rich," he said. "The real reward in medicine is taking care of patients and making them feel better."

But Shanahan says the system doesn't pay enough to cover costs.

"The reimbursement is so low for that - in some cases 60, 80 dollars - it costs you more to get a plumber to come to your house than to get a rheumatologist to come to the hospital," said Shanahan.  

Shanahan says he's one of only a few rheumatologists treating Medicare patients in the Triangle. They make up about 60 percent of his business but pay for a small percentage of the cost to run it.

"The less physicians get paid, the poorer care you're going to receive," said Shanahan.

Right now, Shanahan said Medicare pays him between $40 and $190 to see a new patient and $19 to $134 for follow-up visits. If proposed Medicare cuts kick in by the end of the year, the payments will be about 30 percent less.

"There's a point, an edge, a cliff, that when we get to it, I'm not going to be able to provide that top quality care. If I can't provide the best care, I'm not going to provide any," he said.

And, the Raleigh rheumatologist says he's come to that point, making the difficult decision to stop taking new Medicare patients this year.

"Not by choice but I gotta pay off the business loan I got and I got to pay my staff and I got to pay my malpractice insurance," he explained.

After making several dozen phone calls and searching online, Beverly Frake finally found a primary care physician and a specialist in rheumatology. But she said she's worried about what'll happen when she needs another specialist.

"My family physician cares about her patients. And I don't know what's going to happen with my next need," she said. "I guess I could move back to New York State. I don't really want to at this point because I really like it here."

Medicare officials say 98 percent of doctors in North Carolina have agreed to participate in the program. That's an increase of about 1,000 doctors from last year. But they do not reveal how many patients those doctors are willing to treat, and how many people like our secret shoppers are turned down when they try to find a doctor in the Triangle.

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