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Vashon Health Center alters landscape of senior care on Vashon

Faced with financial difficulties, the Vashon Health Center recently implemented changes that may pose challenges to Island seniors seeking medical care.

In an effort to ensure better reimbursement rates for its services, the center is requiring seniors new to the health center or current patients who turn 65 this year and become eligible for Medicare to purchase medical coverage through a Medicare Advantage Plan rather than through traditional Medicare.

Those who do not have one of the required plans will have to seek care elsewhere unless it is an urgent medical situation, according to Rita Cannell, who manages the clinic.

Vashon Health Center is part of Highline Medical Group of Burien, and Highline has adopted this policy for each of its eight clinics in the Puget Sound area, according to Highline Administrator Susan Pursell.

It has contracted with three insurance carriers that offer Medicare Advantage Plans, and new senior patients or those “aging in” to Medicare must have one of the six plans offered, Pursell said.

The decision to make this change was difficult, Cannell noted.

“This was very, very hard on everybody,” she said. “It was hard on staff, providers and patients.”

According to Pursell, the change was necessary to ensure the financial stability of the health center and the other clinics in the medical group.

Medicare — the insurance program the federal government administers for people 65 and over as well as for younger people with certain disabilities — has become the bane of some physicians and other health care providers because of its low reimbursement rates and the politics that have swirled around it in Congress in recent years.

The program pays physicians less than most private insurance programs, so little, according to Pursell, that Medicare often does not cover the costs of providing care.

What’s more, in the past few years the program’s reimbursement rates have been threatened with cuts that have required congressional intervention to prevent. Indeed, last year, until almost the 11th hour, it looked like Congress might not step in to prevent up to a 30 percent slash in Medicare rates, Pursell said.

It was during this time that Highline administrators decided they needed to take matters into their own hands and sent letters out to patients with Medicare, asking them to switch from traditional Medicare to a Medicare Advantage Plan, which pays health care providers about 20 percent more than traditional Medicare does.

Other medical groups in the Puget Sound region have already made similar changes, Pursell noted, including the Everett Clinic, with nine locations in the Puget Sound region.

“We were late to the game,” she said.

Some affected by the situation are sympathetic to the Highline’s decision.

Islander and senior citizen Melvin Mackey is one of them.

“They’re stuck,” he said. “If I were them, I would do the same thing. It’s too bad they’re put in that kind of position. They don’t know. They can’t plan. They thought there were going to be 30 percent cuts. They can’t take patients and stay in business. They can’t take a loss on a whole bunch of people.”

Others — such as Jeannine Emery, the president of the Granny’s Attic board — see the issue differently.

“I can’t speak for the whole Granny’s Attic board, but I am concerned that the decision limits health care, and that’s the whole point of why Granny’s helps the health center, anyway — to keep local access to health care,” Emery said.

Each month, she added, Granny’s Attic gives the health center $9,000. In addition, Granny’s Attic provides funds for a variety of other needs: patient bills that have not been paid, maintenance needs, remodeling and new equipment.

“Pretty much whatever they ask for, we give them,” Emery said.

Last year, Granny’s provided between $170,000 and $190,000 to the health center, according to Richard Lipke, the business manager at Granny’s Attic. That amount was up some $50,000 from 2009, he said, when Granny’s Attic provided roughly $140,000 to the health center.

In the 30 years that Granny’s has existed, it has easily provided $2 million to $3 million to the clinic, Emery said.

She noted that no one from Highline or the clinic has asked for the board’s input or talked to her about this change in any way. She has been the president for a year, she said, and in that time, no one from Highline has talked to her at all.

In recent interviews, however, both Pursell and Cannell expressed their appreciation for Granny’s support, but both said even with the support, the health center still runs in the red.

“We’ve struggled even with Granny’s support,” Cannell said. “They have really been there for us.”

Other medical clinics on the Island — Chad Magnuson Family Medicine, Vashon Family Practice and Vashon Plaza Medical Clinic — have not made this change and continue to see seniors regardless of their health care coverage.

Magnuson estimates that 30 to 40 percent of his patients are enrolled in Medicare. He said that while the low Medicare payments affect his income, he has no plans to require seniors to switch to an Advantage Plan, but would consider it if he had a large influx of Medicare patients or if Medicare payments were cut from their current levels.

About 25 percent of the patients at Dr. Charles Weispfenning’s office are Medicare patients, said clinic manager Deb Rosser.

“It is a hardship for us,” she said.

But that clinic, too, has no plans to make a change.

“We believe it is (the patients’) choice,” she said. “For Doc, the patients always come first. As long as we have the choice, that is the choice we will make.”

At the health center, though, where about 16 percent of the patients have Medicare, Cannell said the options were limited. The economic downturn was hard for them, she noted, and they have made deep and painful cuts, including losing their long-time triage nurse and a valued medical records professional.

“What else could we cut?” she asked.

— Natalie Johnson contributed reporting to this article.

Medicare Advantage Plans: Be careful when choosing

Medicare Advantage Plans can be a good choice for seniors, especially if they are healthy, some insurance experts say. But they can also cost seniors a lot of money and present other challenges as well, so understanding them and their limitations is important.

Advantage Plans are health insurance plans offered by private insurance companies but funded by the federal government. They cover hospitalization and provide medical coverage, just like traditional Medicare, but they also often include prescription drug coverage as well as other services, such as dental care, eye care and even fitness programs, according to Chewon Lee, of the Washington State Office of the Insurance Commissioner.

When choosing a plan, Lee said, people should be mindful of several key items and pick a plan that works best for them.

Seniors should check with each of their physicians to see if they all accept the plan, he noted. All Highline physicians will accept each of the six plans the medical group has contracted with, but physicians outside of the Highline network might not. This limitation is also important to check if people have a home outside of this area or travel often.

Before enrolling in a plan, seniors should also know the cost of the monthly premiums, if any, as well as co-pays and co-insurance. A plan may have no additional monthly premiums beyond what people pay for Medicare Part B, Lee said, but that does not mean it will necessarily be a savings. If a person has health problems or develops them, the out-of-pocket expenses can be large.

“Costs can rack up pretty quickly,” he said.

Highline Administrator Susan Pursell noted Highline will consider making exceptions for people who cannot find one of the six plans that will work for them.

Patients with questions can contact Highline’s Bonnie Jennings at 878-1985, ext. 246. Free assistance is also available through the insurance commissioners office. Contact the Statewide Health Insurance Benefits Advisors at 1-800-562-6900 or SHIBAhelpLine@oic.wa.gov.

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