Medicare Beneficiaries in Santa Cruz County Hit With Obstacles to Care

Medicare beneficiaries in Santa Cruz County are facing obstacles to care driven by a shortage of primary care physicians and Medicare reimbursement rates that are significantly lower than rates in the nearby San Francisco Bay Area, the Santa Cruz Sentinel reports.

Physician Shortages

Nationally, fewer than 2% of graduates are entering general internal medicine (Wiener, Santa Cruz Sentinel, 2/20).

Many are turning to specialist fields that offer higher reimbursement rates.

Medicare reimburses primary care physicians at markedly lower rates than it does medical specialists, such as those in radiology, orthopedics, anesthesia or dermatology.

Pay Gaps

Under Medicare reimbursement rules, Santa Cruz and 40 other California counties are categorized as "rural," resulting in payments that are about 16% lower than reimbursements for providers in neighboring Santa Clara County.

Because private insurers often base their reimbursement rates on Medicare rates, payments from private health plans also are lower for physicians in Santa Cruz County.

Despite the lower payment rates, the cost of living in Santa Cruz County is significantly higher than in other counties Medicare categorizes as rural (Wiener, Santa Cruz Sentinel, 2/22).

As a result, many physicians who live in Santa Cruz County practice at least part-time in Santa Clara County (Wiener, Santa Cruz Sentinel, 2/21).

Impact on Health Care Safety Net

Many people seeking care in the county are turning to the health care safety net for coverage because of the lack of primary care physicians.

For example, community clinics including the local Planned Parenthood facility are seeing an increase in elderly and disabled patients seeking care, and hospital emergency departments also are seeing a jump in patients.

Lynn Szanto, a case manager for the Dominican Hospital emergency department, said she sees two to three senior patients every month who cannot find a physician in the area (Santa Cruz Sentinel, 2/20).

Proposals

Experts say that health care access for Medicare beneficiaries in Santa Cruz County would improve under a variety of proposals, including:

• Changing Santa Cruz County's reimbursement designation from rural;
• Reducing the disparity in Medicare reimbursements for primary care physicians and specialists;
• Adopting a patient-centered medical homes model of care; and
• Forgiving or reducing medical students' debt to boost the supply of primary care physicians (Santa Cruz Sentinel, 2/22).

In conjunction with the Center for California Health Care Journalism, the Sentinel produced a series of articles, audio slide shows and videos about obstacles to care for Medicare beneficiaries in Santa Cruz County.