The state of Medicare: Local doctors, patients concerned

May 31--For some local doctors, striking a balance between time-consuming new Medicare requirements and dedicated, meaningful patient care has been the challenge of a lifetime.

Doctors, advocates and patients voiced their concerns about physician shortages and upcoming changes to Medicare at a meeting of the Maryland State Medical Society in Frederick on Wednesday evening.

"The purpose of the meeting is really preserving Medicare," said Dr. John Vitarello, a cardiologist who organized the event.

Medicare, he said, is "the most important entitlement program in the United States."

Medicare is a federal health insurance program for people age 65 and older, as well as patients with end stage renal disease or Lou Gehrig's disease. Programs at the state and county levels also help Medicare patients enroll for the program and avoid healthcare fraud.

Doctors were required to start recording clinical data for Medicare patients electronically by 2014. Doctors who did not were penalized with reduced Medicare payouts.

Vitarello said the electronic health record requirements eat away at patients' time.

"What I see and hear is that doctors are spending more time in front of their computers, and not [with] their patients," he said.

About 70 percent of Vitarello's patients at Cardiovascular Specialists of Frederick are on Medicare.

Bud Otis, president of the Frederick County Council, is one of those patients. He said he was "troubled" by the shortage of physicians in the county and the fact that some are no longer accepting Medicare patients.

"I want to do everything I can to help these doctors, because we need them," Otis said.

Dr. Michael Rifkin, who recently retired, attended the meeting. He said the electronic records requirements fundamentally changed his gastroenterology practice after 22 years in medicine.

"There was a ton of fluff in there that you had to figure out what was important," he said.

The record requirements also distanced him from his patients, he said, and slowed the recordkeeping and examination processes.

"Patients didn't like if you typed while you were talking," he said.

Rifkin retired in 2015, about a year after his practice started using electronic health records.

Barbara Connors, a chief medical officer from the federal Centers for Medicare and Medicaid Services, explained the government was trying to address those concerns.

"I think we are really, finally, getting on the right track," she told the group of doctors, patients and advocates during her presentation Wednesday.

Connors mentioned that younger staff members and interns are used to computers and therefore more receptive to electronic records. Doctors in the audience muttered in agreement.

The new Medicare model, which will be active in 2019, would allow more flexible scoring and removes redundant measures, among other changes, according to Connors.

Electronic health records "should not interfere with your practice," she said.

Connors said the federal office is especially interested in hearing from doctors from small practices and rural areas.

"We want to do as much as we can to engage those physicians," she said.

But, some attendees said, recruiting doctors and keeping them in rural areas and western Maryland has been a challenge.

Gene Ransom III is chief executive officer of MedChi, the Maryland State Medical Society.

"I think the workforce issue is serious," he said. "We have a shortage of physicians, and that's already been documented."

He said the shortage is worse in Prince George's County than in Frederick County, but the problem exists statewide.

A 2007 Maryland Physician Workforce Study, sponsored by MedChi and the Maryland Hospital Association, found that the number of residents trained in the state's hospitals will not be sufficient to make up for the wave of doctors who will soon retire.

Residents trained at Maryland hospitals are also opting to start practicing outside the state, as hospital employees or in large group practices, according to the report.

Some doctors and local advocates were divided over whether many or few local physicians had decided to stop accepting new Medicare patients, an issue that would compound the physician shortage issue for those patients.

"You will find a lot of doctors who are not taking new Medicare patients," said Elly Jenkins, who spoke at a Medicare workshop at the Frederick County Department of Aging Wednesday morning.

Ransom said on a statewide level, he had not yet seen a large number of doctors stop taking new Medicare patients.

According to Dr. Randy Culpepper, deputy health officer at the Frederick County Health Department, the county issues surveys to physicians twice a year about whether they are taking new Medicare patients.

"We really only recently began to keep very good information in respect to Medicare," Dr. Culpepper said of the county data.

As of the end of April, there were 103 healthcare providers at family medicine practices in Frederick County. About 50 of them take new Medicare patients.

Of 22 internal medicine practitioners in Frederick County, 12 reported that they take new Medicare patients.

In 2013, Dr. Culpepper said the county only had six family medicine practices, compared to 23 as of April.

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