Medicare Rule Could Cost M.D. Plenty on Third War Tour

May 22nd, 2007 - by admin

Edward Epstein / San Francisco Chronicle – 2007-05-22 00:42:08

WASHINGTON (May 19, 2007) — Dr. Bradley Clair, an Army Reserve cardiologist in Lake County about to begin his third deployment during the Iraq war, is willing to serve his country and endure repeated separations from his wife and four children, but he wants to draw the line at seeing his thriving medical practice destroyed.

Clair faces financial losses of tens of thousands of dollars when he heads to Iraq’s Anbar province at the end of the month because of a Medicare rule about payments to doctors.

Clair’s deployment is scheduled for 90 days, but the anti-fraud Medicare rule ends reimbursements after 60 days for doctors who leave their practices and hire substitutes to care for their patients. After 60 days, departed doctors have to cover the cost themselves — and in the case of a cardiologist such as Clair, with many Medicare-covered elderly patients, that can be ruinous.

The plight of Clair, a 50-year-old who has risen to the rank of lieutenant colonel since joining the Reserve in April 2001, is sparking action in Congress.

The Lakeport doctor’s congressman, Rep. Mike Thompson, D-St. Helena, is introducing legislation that would waive the 60-day rule and allow fill-ins for reservists like Clair to collect Medicare reimbursements for as long as the doctor’s deployment lasts.

Thompson’s bill could be one of those congressional rarities, an idea that has drawn quick bipartisan support because it corrects what members view as an obvious injustice. Officials at the federal agency involved, the Centers for Medicare and Medicaid Services, have told Thompson they won’t oppose the bill.

The American Medical Association has signed on, and the Reserve Officers Association, which represents tens of thousands of military reservists, says it seems a worthy idea.

The bill also reflects the high level of congressional concern for the sacrifices that members of the Reserve and National Guard are making as an overstretched military copes with lengthy wars in Iraq and Afghanistan.

It’s also an issue that transcends opinions about the war. Thompson, an anti-war Democrat, has lined up as his chief co-sponsor Rep. Sam Johnson, R-Texas, the Vietnam War POW who staunchly supports President Bush’s Iraq war policy.

“It’s an honor to serve,” said Clair, who has about 2,500 patients in his practice, many of them elderly and thus covered by Medicare. “But I don’t want my practice to fall apart.

“I’m not going to go broke. I’m a cardiologist, and I make a lot of money,” he said. “But other people don’t make as much money as I do, and this is for them.”

Thompson said he was incredulous when he first heard of Clair’s situation. “It’s just ridiculous that this problem exists. It should take about 15 minutes to fix,” he said. But Medicare told Thompson’s staff that the bureaucracy couldn’t unilaterally change the rules. It would take an act of Congress, signed by the president.

“The same government that’s deploying him is the same one that prohibits him from finding someone to take his patients after 60 days. I’m confident we’ll be able to fix it, because everyone realizes it needs to be fixed,” Thompson said.

Passage of the legislation is a “slam dunk,” predicted Johnson. “I had no idea any law like that existed. It seems to me there shouldn’t be a 60-day limit when doctors are called up.

“It’s just common sense,” he added.

Thompson’s staff estimates that more than 3,000 doctors who belong to the National Guard and the various services’ reserves can be called up to active duty and face a reimbursement problem. But Clair said the scope is probably smaller because a lot of medical reservists got military aid to pay for their medical educations and know they might be the first called up in wartime rather than just attending Reserve weekend meetings and two-week summer camps.

The doctors make up a small slice of the 81,633 Army, Navy, Air Force, Marine Corps and Coast Guard reservists who the Defense Department said are on active duty this month. Many of them, who are usually called up for far longer than Clair, face a hodgepodge of situations about their employment, whether they work for a major corporation or run a small business.

Clair, who operates his practice as a satellite office of Santa Rosa-based Northern California Medical Associates, found replacements to handle his practice during his first two deployments. In 2004 and 2005, he was sent to the Army’s Landstuhl, Germany, hospital for three months at a time to help care for military casualties who are flown to Germany after initial care in Iraq.

Clair thought he had lined up a doctor to take over when his current deployment begins, but on May 5 the substitute had a heart attack and had to undergo a triple bypass operation. Clair is searching for another doctor to come to Lakeport, a popular retirement spot of about 5,200 people, before he leaves for Iraq, where he is scheduled to work as an intensive care specialist.

“Even if I lose more money, I wouldn’t quit” the Reserve, Clair said during a telephone interview.

He won’t offer an opinion about the war itself but is gung-ho about the soldiers he serves. “I love treating soldiers. They’re so appreciative,” Clair said.

“I admit I’m a little nervous about going. There’s some anxiety but for me to practice outside my normal lane as a cardiologist. It’s a test of your skills. … There’s a little juice flowing,” he said.

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