The Great Alaskan Provider Payment Ends

As reported in Managed Care Matters, Alaska’s Sen Ted Stevens (R) engineered a two year $53 Million test by increasing the Medicare provider reimbursements that ended 12/31/2005. The purpose of the program was to see if increasing the provider reimbursement would motivate providers to accept more patients. It appears the program has come to an end, a causality of inconclusive test results and a tepid political atmosphere on additional spending.

The office charges $133 for a 20- to 30-minute office visit with a regular patient. Blue Cross Blue Shield and Aetna — both preferred insurance providers for the clinic — cover about $113 of the $133, Warner said. Medicaid, the government insurance program for people with low incomes, pays $77.61.

Starting in 2006, Medicare will pay the least of all. While the extra money was available, Medicare would cover $87.97 of $133, or 66 percent. Now that the money is gone, Medicare will pay $53.30 for the same visit, or only 40 percent, Warner said. The federal government allows patients to make up some of the difference but not all of it.

Forty percent of an office visit is roughly the same percentage Medicare was paying several years ago when local doctors started dropping out of the program and seniors tried, often unsuccessfully, to find someone to treat them after age 65.

The concern today is providers are going to be asked to do more (with all the changes in benefits and Part D implementation) and compensated at the lowest rate yet. How many providers in Alaska will continue to provide services to Medicare patients…

As Joseph Paduda points out, maybe some of those bridges to nowhere could have been better used to build bridges to Medicare.