Rural seniors beyond reach of HMOs
Mobile Register, September 10, 1999 Section: A Page: 1
Author: BUSTER KANTROW

HMOs seldom serve rural seniors Medicare reform could leave many 'out in cold'
By BUSTER KANTROW

Washington Bureau WASHINGTON - Nearly 95 percent of rural Alabamians who receive Medicare do not have access to health-maintenance organizations, a consumer group reported Thursday.

Families USA said its nationwide findings - which are reflected in Alabama - raise questions about the fairness of Medicare reform proposals that emphasize greater competition among HMOs and the traditional fee-for-service Medicare program.

"The managed-care industry has virtually ignored Medicare beneficiaries in rural communities," the group's executive director, Ron Pollack, said in a statement. "Any Medicare reform proposal that relies on competition among HMOs will leave many seniors out in the cold."

Medicare is the federal health-care program for the elderly and disabled. The majority of recipients participate in a traditional, fee-for-service program. In recent years, however, more beneficiaries have moved into managed-care plans, in which HMOs receive a flat fee for each patient they serve.

Nationwide, about 23 percent of Medicare's 39 million beneficiaries are residents of rural counties, Families USA said.

But 73 percent of those beneficiaries live in counties without participating HMOs, and 17 percent have access to only a single HMO, the group said.

The study, based on Medicare and Census Bureau figures, defined rural counties as those that are not part of a metropolitan statistic area.

In Alabama, which has nearly 240,000 rural Medicare beneficiaries, participants in only one rural county - Walker - have access to a Medicare HMO, the group said. The 45 rural counties without HMOs include Clarke, Conecuh, Escambia and Washington.

Dr. Raymond Fletcher, an associate dean of the College of Medicine at the University of South Alabama, said the pool of patients in rural areas is often too small for HMOs to operate profitably. Doctors are reluctant to join managed-care plans, because they can do better on their own, billing Medicare for individual services.

"In general, rural hospitals and rural physicians will take even a greater hit" by joining HMOs, said Fletcher, the director of USA's telemedicine program. "There's no incentive."

He said the situation is likely to worsen because of cutbacks in Medicare and Medicaid reimbursement rates that Congress imposed several years ago.

"There's just too little money," he said.

Cleve Money, a research analyst with the Alabama health department, said rural recipients of Medicare and Medicaid are actually better off than poor residents who do not qualify for federal health assistance. Money oversees the health department's periodic surveys on the availability of primary care.

"The surveys point out, almost without fail, at least adequate access and in some cases excellent access for Medicare and Medicaid cardholders," Money said. "The real grind comes in when you have a poor person who does not have private insurance."

Families USA said no HMOs are available to rural Medicare beneficiaries in 13 states. Alabama is among 14 states in which only one HMO is available to many beneficiaries, it said.

The group attributed HMOs' absence from many rural markets to the scarcity of rural providers and patients. It said rural beneficiaries also tend to be somewhat less healthy than urban Medicare participants.

Families USA was particularly critical of a Medicare-reform proposal that would force traditional Medicare to compete with private plans. The proposal was developed by a federal Medicare reform commission.

Although traditional Medicare would remain, healthier patients will opt out and the cost will rise for the patients who remain, the group said.

This article reproduced with special permission from the Mobile Register.