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Originally published October 19, 2007 at 12:00 AM | Page modified October 19, 2007 at 2:03 AM

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The Everett Clinic to stop accepting one Medicare plan

When Connie Sawyer's longtime physician moved to Seattle from Sultan recently, she had a hard time finding a new doctor she liked. So the retired legal...

Seattle Times health reporter

When Connie Sawyer's longtime physician moved to Seattle from Sultan recently, she had a hard time finding a new doctor she liked. So the retired legal secretary turned to The Everett Clinic, one of Washington's largest chains of medical clinics, even though it is 20 miles from home.

But the 71-year-old never got past the appointment desk. The doctor she wanted to see wouldn't take her because she is covered under the wrong kind of Medicare.

"I was just stunned," Sawyer said.

Now 1,400 current patients of the The Everett Clinic are about to feel that same sting of rejection.

The clinic is mailing letters to the seniors to say it won't take their type of "fee-for-service" Medicare plan after December 2008. To keep their doctors, they'll have to switch to a different, managed-care Medicare plan.

And The Everett Clinic also may eventually reconsider whether to continue to accept the regular, "original" Medicare plan — the plan of choice for 65 percent of the clinic's 20,000 Medicare patients.

The move is part of a nationwide effort to push more seniors into managed-care Medicare plans, which typically pay doctors better than fee-for-service plans and give doctors more control over medical services they provide.

Four out of five American seniors have Original Medicare, a fee-for-service plan that can be used with any doctor who participates in the program. The federal government pays the claims. The other 20 percent are enrolled in "private" Medicare Advantage plans, which are sold by commercial insurers and are set up either as fee-for-service or as managed-care plans, which generally restrict patients to a network of hospitals and doctors.

Enrollment in the private Medicare plans has been growing rapidly, in part because they typically include extra benefits the Original Medicare system doesn't. And providers are actively steering their patients into Medicare Advantage managed-care plans because they typically hold down medical costs.

For example, The Polyclinic, also a major medical chain in the area, is considering whether to limit all new Medicare patients to only those covered by private managed-care plans. Some individual doctors there already are rejecting new fee-for-service patients.

The Polyclinic hasn't decided what to do with its existing Original Medicare patients.

Chief Executive Lloyd David said that decision will depend on whether there are further cuts in Medicare reimbursement, among other issues.

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"We really hope it doesn't come to that," David said.

Currently, The Everett Clinic loses money on most fee-for-service Medicare patients, while managed-care plans are "close to break-even," said Rick Cooper, its chief executive. So the clinic will no longer accept private fee-for-service Medicare plans starting in 2009 and will defer a decision on what to do about patients on Original Medicare for now.

Such decisions nationwide are likely to gradually kill off Original Medicare, laments Dr. Bob Berenson, a former Medicare official who is now a senior fellow at the nonprofit Urban Institute, a Washington, D.C., think tank.

Berenson predicts that the federal subsidy for all private Medicare plans will prove too costly and dry up eventually, making them less lucrative to providers.

If Americans continue to defect from Original Medicare to private plans, Berenson worries it would undermine "a good social-insurance plan and turn it over to money-making companies."

Kyung Song: 206-464-2423 or ksong@seattletimes.com

Copyright © 2007 The Seattle Times Company

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