"It almost sounds too good to be true." That's the first sentence of the editorial "Medicare opportunity" (March 7,) supporting a Medicare clinic. Indeed, the Daily News has not looked into this issue thoroughly. The editorial praises the concept, as well as the retired doctor whose vision it is, for the clinic.
Let's back up -- the editorial does not mention the source of the $1 million that is being requested for the clinic. That would be House Bill 335, the first of two steps to fund such a clinic.
HB 335 does not include the retired doctor's name as the recipient of any funds, nor details of the clinic. And that is how it should be -- no legislation can be written for a particular recipient.
Yet it seems to be a given that this grant is directed toward a particular clinic model and person. Even the Alaska Commission on Aging supports the Medicare clinic plan without mentioning HB335. On Feb. 12, legislators met with the group requesting start-up funds. The legislators were given a business plan that hinted at how the clinic might function. But reading between the lines should scare all seniors.
The clinic's business plan states their mission, as a nonprofit, would include innovation and efficiency (as should any business). Outpatient illnesses, but not injuries/emergencies, would be handled five days a week. An appointment would go like this: Client is seen for one diagnosis by a nurse or other medical assistant/practitioner; then the physician or nurse practitioner sees the client where physical findings and diagnosis are confirmed and further treatment is suggested; the medical assistant or nurse returns with instructions and prescriptions, after which the nurse completes the medical record. Each nurse or practitioner will see two or three clients an hour, up to about 24 per day. The physician is expected to see up to 32 per day, as well as be an administrator to the clinic and staff. The plan states the need for their clinic is because private primary care doctors are limiting the number of Medicare clients they see and this trend is expected to continue.
Dissecting this information, I find that the letter from the Alaska Commission on Aging refers to this clinic model as the "single diagnosis protocol model." In other words if I have several medical problems, I cannot get them addressed in one visit; I have to make separate appointments. Repeat visits mean more billings to Medicare and more income, but it does not translate into comprehensive care, nor does it advance the current trend toward positive outcomes. A diabetic is likely to have multiple problems from high blood pressure, kidney failure, glaucoma to foot ulcers. Treatment should be all-inclusive.
The ADN editorial on June 5, 2008 supported a similar idea from this same doctor with a model that limited client-physician contact to five minutes per appointment, for one diagnosis. This proposed Medicare clinic is the same, bad idea.
It's true that primary care physicians are limiting the number of Medicare clients -- if they see them at all. It is simply a matter of economics. They can't keep the doors open if they see too many people whose insurance only pays 40 percent of the bill. But what this Medicare clinic is likely to do is to cause more primary doctors to drop their elderly clients and send them all to the new clinic. That side effect has not been addressed.
There could be other, viable options for serving the elderly through grants from HB 335 -- perhaps other, established neighborhood clinics could use the funds to expand their current operations. But with legislators focused only on one model and recipient, the public may not be well-served.
Certainly I do not feel I will be served well by a "single diagnosis protocol model," five minutes with an M.D., accompanied with the risk of being given the boot by my primary care doctor. Juneau, in your haste to do something for elders, first determine that you're doing no harm.
Dianne Holmes is a community activist and Medicare patient who lives in Anchorage.
By DIANNE HOLMES