RMA considers
options for
replacing revenue

By Mary Garrison
Tribune-Courier Features Editor
mgarrison@tribunecourier.com

DRAFFENVILLE – Differences of opinion are more than just fuel for debate, on Capitol Hill they’re a way of life. However, one of the most recent Senate stalemates to create headlines involved Kentucky Senator Jim Bunning in his funding block for the extension of unemployment benefits, road projects and Medicare payments.

While Bunning relented some days later, for many in the healthcare industry, the concept was nothing new. It’s a crunch some say they have felt for the last year.

Brad Warning, business administrator for Regional Medical Associates in Draffenville, said his facility has been walking on eggshells since talk of healthcare reform began.

Warning said RMA has been working to adjust its practice in preparation of the 21 percent comprehensive Medicare reimbursement cut anticipated for several months. That, coupled with the promise of an 18 percent reduction in fees paid for certain services from 2009 to 2010, prompted RMA to take action.

“[At one point] we determined not to accept any new Medicare patients,” Warning said. “We planned on continuing care for current Medicare patients, we just weren’t going to accept any new ones.”

Warning said it was a step no one wanted to take; however, with 19 percent of its patient load on Medicare, Warning said RMA had little choice.

Fortunately for Medicare patients, things, for the moment, have changed. Warning said after turning in claims to Medicare, staff discovered upon reimbursement that the agency actually paid more toward services than it had in the previous year.

“So, we went back to sqaure one,” Warning said. RMA started accepting new Medicare patients once more, though he said staff remains mindful of predicted cuts.

“It was supposed to happen on March 1,” Warning said. “It has apparently been delayed again. The thing is, we never really know what is going on until we send in a claim and it’s sent back to us.”

Warning said currently, RMA has approximately 38,000 active patient files — those that have visited the facility within the last three years — many of which he said are from surrounding counties, with facilities no longer accepting Medicare patients.

“We’re one of the only family care practices in the area still accepting Medicare patients,” Warning said. “Continuing cuts will limit the way we can care for them.”

For the time being, no cuts to specific services have been made, and the 21 percent across the board funding cut has yet to happen, though RMA has begun calculating co-pay premiums and asking for payment up front instead of sending out monthly bills.

Currently, for a standard $75 office visit, Warning said Medicare will pay approximately $59.

“We’ve cut costs considerably,” he said. “We’ve streamlined operations, cutting staff down from 55 employees to 36 in the last three years. Obviously we’re going to have to generate revenue somewhere when this happens. We’ve got expenses that won’t go away just like any other business.”

There are other solutions, Warning said, that could work to the benefit of both healthcare providers and patients. Offering free basic lab work, he said, could give patients a better view of their health while potentially addressing issues they otherwise overlook.

“A lot of people, I think, are very reluctant to visit the doctor,” Warning said. “If we’re offering free services like bloodwork, and they come in and tests reveal something may be wrong, they’ve got the motivation to get it taken care of and it allows us to generate revenue otherwise lost.”

He said, ultimately, it is the patients for whom he feels sympathy. Medicare guidelines are “virtually impossible” to interpret on both sides of the spectrum, Warning said, and he fears cuts and uncertainty of healthcare reform will lead to patients slipping through the cracks.

Said Warning: “All of healthcare is under a strain right now. For the moment we’re doing the best we can and we’ll continue to do so until we feel like we can’t take the hit anymore.”