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Medicare Fees Debate Stirs Uproar

October 7, 1997

WASHINGTON (AP) _ The issue of whether senior citizens on Medicare should have the choice of paying doctors’ bills out of their own pockets has created a political uproar.

Because of a recent change in federal law, the nearly 37 million seniors with Medicare doctors’ office coverage would, for the first time next year, be allowed to pay to receive care from those doctors who don’t participate in the government’s health insurance program for the elderly.

But the nation’s largest doctors group and a number of conservatives complain that most doctors still wouldn’t accept private-paying patients under the change in the law because if they did, they would be barred from seeing the larger universe of patients who want to use Medicare.

``For some time now there have been certain patients who have said we’re willing to pay our own doctors’ regular fees _ because of access or whatever,″ said Dr. Thomas Reardon, chairman of the American Medical Association. ``Why shouldn’t the physician be able to contract (with them) and still see other Medicare patients?″

The AMA is lobbying hard for a bill sponsored by Sen. Jon Kyl, R-Ariz., and key Republican leaders that would let doctors who ordinarily accept Medicare name their price whenever older people are willing and able to pay.

President Clinton disapproves. Republicans say to get it past him they may try to attach the measure to legislation Clinton badly wants, such as a free trade measure.

``It’s critical that we get it done,″ Kyl said.

The dispute does not involve services not covered by Medicare, such as some preventative health screenings and elective procedures. These will continue to be available to any patient willing to pay private prices or find private insurance coverage.

And seniors always have the option of not enrolling in Medicare; in such cases, the restrictions on doctors don’t apply.

Until the recent change, it had been illegal for any doctor to bill a Medicare patient at private rates for services that otherwise would be covered under Medicare’s standard fees, which are generally lower.

That rule, designed to protect seniors from price-gouging, also had cut off Medicare patients from doctors who wouldn’t take Medicare. That was especially a problem in cases of rare specialists or lone practitioners in isolated areas who wouldn’t accept Medicare payments.

Lawmakers seeking a solution to that problem got it changed as part of this summer’s budget deal that was approved by Congress and the president.

In return for that change, the Clinton administration demanded and won a provision that would make a doctor give up all claims on Medicare for two years if the doctor saw Medicare patients who paid private rates.

That provision, the administration officials said, would discourage doctors now accepting Medicare from in the future turning away new patients unless the patients paid privately. It also would prevent doctors from refusing certain treatments to those who want to use Medicare coverage.

``We want to make sure that Medicare beneficiaries have the same access to high quality health care as those who choose private contracts,″ Medicare spokesman Chris Peacock said.

Letting doctors mix and match payment plans for Medicare patients also would make it harder for the government to keep track of its share of fees, said the nation’s largest senior citizen’s group.

``It really does begin to open up a whole new spigot for unscrupulous operators to rip off beneficiaries and rip off the Medicare program,″ said Martin Corry of the American Association of Retired Persons.

Yet, most doctors don’t want to and couldn’t afford to turn away the hordes of seniors who rely on Medicare, AMA officials said. About 5 percent of U.S. doctors now refuse to accept Medicare patients, generally because of the lower fees they bring.

Conservative groups contend that will become more of a problem as Medicare reimbursement rates drop under the budget deal. More doctors may decide to limit the number of Medicare patients they’re willing to take _ and those patients left out could be prevented from seeing the doctor of their choice unless they can arrange to pay privately.

``It really is a safety valve as we get down the road and (Medicare) reimbursements keep getting lower,″ said Mike Korbey of the United Seniors Association. ``We need to make sure people can go outside the system.″