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Clinics tapping Medicare market

Drs. Brita Feliciano, left, and Veronica Ruiz talk in the hall at the Rockwood Clinic on the South Hill on Friday. Ruiz has been with Rockwood since February 2011, and Feliciano joined in October 2011. They are part of a cadre of doctors who are building their practices with Rockwood. (Jesse Tinsley)
Drs. Brita Feliciano, left, and Veronica Ruiz talk in the hall at the Rockwood Clinic on the South Hill on Friday. Ruiz has been with Rockwood since February 2011, and Feliciano joined in October 2011. They are part of a cadre of doctors who are building their practices with Rockwood. (Jesse Tinsley)

Surge in demand expected in coming years

Large Spokane clinics say they are hiring more doctors to absorb the growing numbers of new Medicare patients.

Rockwood Clinic, for example, hired 13 primary care physicians last year and plans to hire 13 more this year.

And Providence Medical Group has tripled the number of doctors in its practice in the past two years.

While the moves are an effort to meet the needs of an aging population, enrolling new patients also secures a base of new patients for affiliated hospitals.

Rockwood has been touting its new clinic in north Spokane established specifically for new Medicare patients. The clinic is a sort of triage center where patients are added to Rockwood’s integrated health system – a marriage of medical services that includes both the multispecialty clinic and Deaconess and Valley hospitals. All three are owned by Community Health Services Inc.

Dr. Craig Whiting, Rockwood’s local chief executive, said new patients will have their medical records and history entered and then will be appointed a doctor based on their needs. Most likely the doctor will be one in practice near the patient’s residence unless the patient requests a specific physician and the clinic can accommodate that request.

There has been a strong push to retain and recruit more doctors who practice family or internal medicine throughout Eastern Washington, where physician shortages are especially worrisome for rural communities with aging populations.

Settling on the right payer mix to keep a clinic financially viable is a balancing act. Medicare often accounts for about 1 in 4 patients at a typical primary care clinic.

It’s stayed at that relatively low level because the federal government program reimburses clinics at levels below that of private pay patients.

Providence also has grown its Spokane-area medical group during the past two years; in 2010 Providence had a total of 70 primary care physicians and specialists along with 10 advanced practitioners.

Today the medical group, which also owns Sacred Heart Medical Center and Holy Family Hospital, has 200 doctors and 50 advanced practitioners.

Much of the medical group’s growth is attributed to purchasing the independent practices of longtime physicians, said Dr. Kevin Sweeny, who joined Providence as a physician recruiter. It’s become harder for independent clinics to operate because of financial pressures and the uncertainty of health care reform, he said.

“The growth of the medical group has been good for Providence,” Sweeny said, “and it has helped stabilize the primary-care workforce.

“That’s important because the Medicare population is poised to explode in the coming years” as baby boomers reach age 65, Sweeny said.

Providence always makes room for more Medicare patients, he said, and will continue adding more physicians to keep pace.

Sweeny noted that while clinics are accepting new Medicare patients, they also need to brace for large numbers of new Medicaid patients.

The new health insurance exchanges required by federal health care reform efforts could award health insurance or Medicaid coverage to 380,000 currently uninsured people across Washington.

Sweeny said those newly insured patients will need to have a family doctor and communities may not have enough to handle such pent-up demand.

The latest state survey of primary care providers, taken in 2009, determined that Spokane County had 296 primary care providers.

Of those, 79 percent, or 171 doctors, treated Medicare patients. And of those 171 doctors, about a third were accepting new Medicare enrollees, though many declined to treat patients in need of prescription medications, said Phi Ly, survey coordinator for the state Department of Health.

The survey helps health officials analyze doctor shortages.

Group Health Cooperative, another large primary care provider, has a different approach to meeting the need of handling more Medicare patients.

It is actively recruiting and accepting Medicare patients as long as they buy its Medicare Advantage Plan, a supplemental plan that on average costs about an extra $20 a month.

That plan fits Group Health’s “medical home” model for care that delivers a broader, more coordinated range of health care services other than visiting the doctor when ill, said Dr. Tom Schaaf, Group Health’s medical director for Eastern Washington.



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