By Martin M. Bress, M.D.
A crisis in medical care delivery and patient access for medical
services is threatening San Benito County. This crisis is being
precipitated by a Medicare program that doesn’t follow its own
regulations, a congressman who seems powerless to help us, and
private insurance companies that are gouging the public through
increases in premiums and decreases in payment for medical
services.
A crisis in medical care delivery and patient access for medical services is threatening San Benito County. This crisis is being precipitated by a Medicare program that doesn’t follow its own regulations, a congressman who seems powerless to help us, and private insurance companies that are gouging the public through increases in premiums and decreases in payment for medical services.
In 1973, I came to Hollister as a member of the United States Public Health Service in a program called the National Health Service Corps. The program’s purpose was to place physicians in areas that were medically underserved. It is now 34 years later, and, hard as it may be to believe, San Benito County still has an inadequate number of physicians to serve the current population, though much progress has been made.
We have recruited numerous specialists and additional primary care physicians. Hazel Hawkins Hospital has continued to upgrade its physical plant and increase its range of services, and it is a facility in which the community can take pride. All this progress could be washed away by the looming storm if citizens do not take action.
For many years, San Benito County physicians have been burdened by inadequate reimbursement from Medicare. The Medicare Program has not followed its own regulations in updating the cost of providing medical care.
Congressman Sam Farr, our local representative, is introducing a bill, HR 2484, which supposedly mandates that Medicare follow its own rules and update medical costs every few years. Based on out-of-date statistics, this bill would increase reimbursement for physicians in Santa Cruz, Monterey and eight other counties, but not San Benito.
The physicians of San Benito County feel betrayed by this lack of representation for our interests and those of our patients. This will continue to result in Gilroy physicians who practice in Santa Clara County receiving reimbursement from Medicare 15 percent to 20 percent higher than those of San Benito physicians for every single service. In the past, we have lost physicians to Gilroy and elsewhere, and in the future, we will probably lose more.
In 2008, it is projected that Medicare will lower its reimbursement 10 percent as part of its budget process. This will result in physicians having to limit the number of Medicare patients they can afford to serve.
For years, private insurance companies have developed their reimbursement schedules with full knowledge of Medicare rates. Thus, physicians have been doubly penalized.
In the latest outrage, Blue Cross of California, the largest private insurer in our county, has stated that in August, it is instituting a new fee schedule for San Benito County doctors, which is 15 percent below current Medicare rates for evaluation and management services. These rates come from insurance companies that annually raises premiums for its policies 15 percent to 20 percent. Blue Cross profits nearly a billion dollars per quarter.
In 2006, 293 executives of Blue Cross’ parent company, Wellpoint, received $365 million dollars in bonus payments. Blue Cross spends the lowest percentage of its premium income on medical services compared to the private insurance companies. The perfect storm is coming, and physicians in San Benito County are coming to the realization they will not be able to continue to care for Blue Cross patients unless Blue Cross stops putting profits before patients.
The medical provider network in Hollister is of exceptional quality, as nearly all physicians here are recruited and their qualifications carefully assessed. However, the absolute number of physicians and surgeons in the county is extremely small, thus making the medical network potentially fragile. If our surgeons are forced to relocate, if our medical specialists conclude it is no longer feasible to serve San Benito residents, if our primary care physicians are no longer able to accept new patients, or if our older physicians are forced into early retirement, a medical care crisis will envelop San Benito County that will endanger the well-being of our residents and the viability of our local hospital.
There are two separate issues that demand attention: corporate greed and government bureaucracy. Many local physicians have tried to tackle the problems with no success. Residents who have Blue Cross coverage should ask their employers to seek insurance coverage from other insurance companies, such as Aetna, Blue Shield, Cigna and many others, which pay a fair fee for medical services. If not, they may find that their access to medical services has either been limited or disappeared.
Three years ago other physicians and I met with Farr to alert him of the negative impact of Medicare’s formula, but nothing has changed. In fact, the situation has worsened. Just the other day, I was informed by Farr’s office he could not do any more for the residents and physicians of San Benito County.
Perhaps he will be more responsive to the public. I urge you to contact him regarding this critical matter at www.farr.house.gov or 800-340-FARR and 202-225-5861.
Martin Bress is doctor at Hazel Hawkins Hospital in Hollister.
