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Doctor shortage
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| H&N photo by Andrew Mariman Dr. Geoff Marx confers with his wife and office manager, Nancy, Tuesday in the office of his internal medicine practice. Marx has practiced medicine in the Basin for 31 years and is partially retiring in the spring of 2009, due in part to lack of Medicare reimbursements. He will take up part-time work at Sky Lakes Medical Center. |
Officials: Lack of physicians at crisis stage
By STEVE KADEL
H&N Staff Writer
Klamath County’s lack of primary care physicians has reached crisis proportions, according to local medical officials. At the same time, a large number of uninsured patients is straining the staffs of medical clinics.
“There is too much demand and too little supply,” said Bob Marsalli, CEO of Klamath Open Door Family Practice. “About 50 percent of the people we see each day don’t have health insurance.”
Other uninsured people use the Sky Lakes Medical Center emergency room for routine ailments, which Marsalli said is “always a bad idea unless it’s an emergency.”
But Marsalli said many other uninsured people go to community health centers like Klamath Open Door, which gets federal grants that help offset the cost to care for the uninsured.
Despite that, there’s still a payment shortfall.
“We are all operating at very small margins of profitability,” Marsalli said. “In the current environment, primary care is not reimbursed as well as specialty care.”
He believes a partial solution to the primary care dilemma is to use nurse case managers for routine problems so appointments with physicians are reserved for more acute patients.
Marsalli added that Klamath County is not alone in having too few family care physicians for the number of patients.
“There are clinics like ours all over the state working on innovations about how health care is delivered,” he said.
In the meantime, Klamath Open Door must weigh the price of treating the uninsured.
“If you can’t cover your costs, you have to start saying no,” Marsalli said. “We are in this together. It’s not just one person’s or one clinic’s problem.”
No insurance
Dr. Ralph Eccles of Cascades East Family Practice Center said about 25 percent of its patients have no insurance.
The District 10 representative for the Oregon Medical Board of Trustees said there’s a crucial need for more doctors, nurses, physical therapists and pharmacists in Klamath County.
Part of the problem in attracting doctors to rural areas is the disparity that Medicare pays in the Portland area and in rural Oregon.
Eccles said Clackamas, Multnomah and Washington county clinics are funded at nearly full level for various services while Medicare reimburses rural clinics at roughly two-thirds of that amount.
Oregon and Washington medical associations are petitioning Medicare to increase payments to rural areas. Eccles noted that Sens. Gordon Smith, R-Ore., and Ron Wyden, D-Ore., both support that move.
New patients each day
Eccles said Cascades East sees two to five new patients a day, mostly people who moved here from California without a job. They come here because they can’t afford to live in California and find the cost of living less in Klamath County.
“We’re having a huge influx,” Eccles said.
He said Cascades East does its best to treat everyone who comes through the door.
However, appointments for new patients may have to be scheduled six weeks out.
The volume of patients at Cascades East has risen steadily over the past few years. More than 1,800 patients were treated during September — up almost 400 patients from the same month in 2006.
For more on the local doctor shortage, see Sunday's Herald and News print edition.
“There is too much demand and too little supply,” said Bob Marsalli, CEO of Klamath Open Door Family Practice. “About 50 percent of the people we see each day don’t have health insurance.”
Other uninsured people use the Sky Lakes Medical Center emergency room for routine ailments, which Marsalli said is “always a bad idea unless it’s an emergency.”
But Marsalli said many other uninsured people go to community health centers like Klamath Open Door, which gets federal grants that help offset the cost to care for the uninsured.
Despite that, there’s still a payment shortfall.
“We are all operating at very small margins of profitability,” Marsalli said. “In the current environment, primary care is not reimbursed as well as specialty care.”
He believes a partial solution to the primary care dilemma is to use nurse case managers for routine problems so appointments with physicians are reserved for more acute patients.
Marsalli added that Klamath County is not alone in having too few family care physicians for the number of patients.
“There are clinics like ours all over the state working on innovations about how health care is delivered,” he said.
In the meantime, Klamath Open Door must weigh the price of treating the uninsured.
“If you can’t cover your costs, you have to start saying no,” Marsalli said. “We are in this together. It’s not just one person’s or one clinic’s problem.”
No insurance
Dr. Ralph Eccles of Cascades East Family Practice Center said about 25 percent of its patients have no insurance.
The District 10 representative for the Oregon Medical Board of Trustees said there’s a crucial need for more doctors, nurses, physical therapists and pharmacists in Klamath County.
Part of the problem in attracting doctors to rural areas is the disparity that Medicare pays in the Portland area and in rural Oregon.
Eccles said Clackamas, Multnomah and Washington county clinics are funded at nearly full level for various services while Medicare reimburses rural clinics at roughly two-thirds of that amount.
Oregon and Washington medical associations are petitioning Medicare to increase payments to rural areas. Eccles noted that Sens. Gordon Smith, R-Ore., and Ron Wyden, D-Ore., both support that move.
New patients each day
Eccles said Cascades East sees two to five new patients a day, mostly people who moved here from California without a job. They come here because they can’t afford to live in California and find the cost of living less in Klamath County.
“We’re having a huge influx,” Eccles said.
He said Cascades East does its best to treat everyone who comes through the door.
However, appointments for new patients may have to be scheduled six weeks out.
The volume of patients at Cascades East has risen steadily over the past few years. More than 1,800 patients were treated during September — up almost 400 patients from the same month in 2006.
For more on the local doctor shortage, see Sunday's Herald and News print edition.
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LT wrote on Oct 19, 2008 7:48 PM:
" Out of Clackamas County's three primary care clinics, one closed in June of this year, another is set to close in December, and the third and final clinic will close in less than two years. Clackamas County is getting out of the primary care business altogether, thanks largely to the skyrocketing cost of providing care and our inability to obtain payment from the unisured. "
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Decades wrote on Oct 19, 2008 7:51 PM: