UTAHNS ASSAIL MEDICARE REIMBURSEMENT FORMULAS

Medicare reimbursement formulas cheat Utah doctors and patients - and have some Utah doctors moving away or refusing Medicare patients, a Utah senator and physician told Congress on Thursday.

Sen. Orrin Hatch, R-Utah, and Salt Lake physician Alan R. Nelson, president-elect of the American Medical Society, told the Senate Finance Subcommittee on Medicare and Long Term Care that the situation threatens future care of senior citizens.Hatch testified, "We now have a reimbursement system in which physicians providing exactly the same service are reimbursed at very different levels depending on whether the office is on one side of the state line or another."

He added: "Neighboring states receive up to 20 percent more for services provided in the office than do physicians practicing in Utah. For physicians providing hospital care, this discrepancy can be as high as 33 percent."

And Nelson said that on average nationally - which Utah doctors are apparently below - Medicare reimburses doctors for only 73 percent of their regular fee, compared to the 90 percent it reimbursed in 1970.

Hatch said studies show Utah doctors now face costs that are as high or higher than in other states, but current reimbursement formulas were drafted in 1973 when costs were lower in the state.

The result, Hatch said, is "I have been told that physicians practicing in Utah are moving their practices to neighboring states with higher reimbursement rates, and I fear young physicians may decide to avoid practicing in Utah altogether."

Hatch added: "If this trend continues, many seniors in Utah may have difficulty finding a doctor when they need one. Compounding this trend, more and more physicians who remain in Utah are reluctant to accept assignment of Medicare patients.'

The situation also hurts non-Medicare patients in Utah, Hatch said. "Physicians who do remain in Utah - and are reimbursed below costs - face no alternative but to increase their charges to other payers."

He said Utahns also are subsidizing Medicare recipients in other states.

Nelson also attacked proposed "expenditure targets" for Medicaid by doctors, which some hope would hold down costs for the federal government but that Nelson says would lead to rationing of health care.

He said that in Canada, which has experimented with such targets, "patients have died after long waits for surgery. . . . The wait in Vancouver for psychiatric, neurosurgical or routine orthopedic consultation is one to three months, six to nine months for cataract extraction, two to four years for corneal transplantation and six to 18 months for admission to a long-term placement bed."