Doctors struggle to visit Medicare patients at home
The program's payment rates are among the obstacles.
By Markian Hawryluk, amednews staff. Oct. 6, 2003.
Washington -- The average patient seen by Leslee Cochrane, MD, is 83 years old, has multiple chronic conditions, is in the last two years of life and rarely leaves home.
The Riverside, Calif., family physician is one of a slow trickle of doctors reviving the age-old tradition of house calls to treat nontraditional Medicare patients -- those who are too sick to leave their homes to see a doctor. Yet despite a commitment to serve this vulnerable group of beneficiaries, Dr. Cochrane and others like him are struggling with Medicare's home care policies.
"Medicare does not appear to have a way to look at doctors by virtue of their practice population," he said. "What they do is compare me to other family practice doctors in Riverside County. I look like a big bull's eye."
Computer software used by his Medicare contractor continually flags Dr. Cochrane as having a more complex case load than is typical for his specialty. That's often a sign of fraud.
But in Dr. Cochrane's case, it's another sign that Medicare hasn't adequately fit patients with chronic conditions and the physicians who treat them into its payment structure. So physicians who make house calls are having claims routinely denied.
"The most commonly cited reason is frequency," he said. "If you take a frail, homebound elderly person, chances are they are sick enough they need to see a doctor more frequently" than elderly healthy people able to drive cars to see their doctors.
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