Dr. Thomas Told, D.O., fills out an application for Medicaid reimbursement.

Photo by Collin Smith

Dr. Thomas Told, D.O., fills out an application for Medicaid reimbursement.

Doctors struggle with government insurance

Cuts make it hard to accept certain forms

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By the numbers

What some health-care providers said:

• Thirty six percent of the hospital's patients are on Medicare, and 8 percent of them are on Medicaid. - George Rohrich, TMH CEO

• About 36 percent of Craig Medical Center patients subscribe to Medicare or Medicaid. - Dr. Thomas Told, D.O., of Craig Medical Center

• In 2006, 974 Moffat County residents were on Medicaid, and 253 children had coverage from Child Health Plan Plus, the Colorado SCHIP program. - Cole White, VNA community care director

— Doctors are having a hard time coping with some financial realities caused by Medicaid, Medicare and State Children's Health Insurance Program.

That means some might stop accepting those insurances in the future.

"Congress knows doctors will step up to the plate to see patients," said Dr. Thomas Told, D.O., a family practitioner with Craig Medical Center. "It has always been the philosophy of this clinic (to accept new Medicaid patients). We didn't think the community would be served by closing our doors to them."

Physicians are paid through a system that passes on Medicaid, Medicare and SCHIP deficits to them.

In other words, when those insurance systems spend more money than they are budgeted for, which has happened each of the past 10 years, the government makes up the difference by reimbursing physicians less, Told said.

Doctors are now faced with a possible 9.8 percent cut in those reimbursements in the coming months. This comes after the U.S. Congress said it would lock the reimbursement rate, Told added.

"That 10 percent cut is probably going to be the death knell for a lot of physicians," he added.

Told plans to travel to Washington, D.C., on Thursday to meet with the Federal Health Council of the American Osteopathic Association to discuss how to convince Congress cutting physician reimbursement could have dire consequences.

The reality for doctors is even tougher when taking into account that government health insurance programs set the prices they accept for procedures.

"The government is the price-setter, and docs are the price-takers," said Cole White, Northwest Colorado Visiting Nurse Association community care director. "In hospitals, Medicaid reimburses about 20 to 25 cents on the dollar of what some procedures' actual costs are to the hospital."

What health care providers ultimately end up doing is hoping they have enough patients with private insurance or private payment to offset the losses from government insurance programs, White said.

As a not-for-profit entity, the VNA is different from clinics and hospitals, White said. Most of its programs don't make any money at all, he said, but the VNA receives grant revenue to sustain itself.

The VNA recently applied to enroll in the physician's plan of Medicare coverage and expects to hear about its application status by mid-September.

Until now, Medicare and Medicaid patients were write-offs for the clinic because it cost more in time and work to seek reimbursement than it did to accept the patient visit as free, White said.

In the future, the VNA wants status as a federally qualified health center, which would provide full-cost reimbursement for Medicaid procedures and a high percentage for Medicare.

That is similar to The Memorial Hospital's designation as a critical access hospital, which provides it with full reimbursement for Medicare and requires it to accept all Medicare patients.

It's not a total reimbursement, though, TMH CEO George Rohrich said.

"It only covers certain costs and certain procedures."

Even with high reimbursements, the hospital still has several issues with how Medicare is operated.

"The Medicare manual is over 300,000 pages long of procedures and protocols," Rohrich said. "It is only rivaled by the IRS tax code. If a hospital or physician has a question, they can't call Medicare because they'll only refer us to the manual. It's known for being uncooperative."

Rohrich and Told both agree the American health care system is broken and hinders quality doctors from giving quality care.

"We've got a crisis in this country with health care," Rohrich said. "It's well-known, well-documented and it'll be interesting to see who will step up and have the guts to fix the system."

"Could we take a 10 percent (reimbursement) hit? I don't know," Told said. "It means we have to cut back on other services. We have a commitment to those people to continue to treat them, but we also have a commitment to offer comprehensive medical services. We'll have to look at our budget at that time."

Collin Smith can be reached at 824-7031, ext. 209, or cesmith@craigdailypress.com

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