Thousands of patients seek new providers as closure of Anchorage senior health clinic looms

Feb. 24—Anchorage's health care system is feeling the strain as thousands of older adults seek new medical providers due to the abrupt closure of a longtime clinic that's left patients scrambling for care.

The Alaska Regional Senior Health Clinic announced late last month it was closing on Feb. 28, citing staffing problems, after operating for over a decade as one of few facilities accepting Medicare in the city. Some patients described being unable to get through to the clinic's front desk or schedule important visits in months and reported multiple last-minute cancellations.

An Alaska Regional spokeswoman declined to specify how many patients the clinic serves. But multiple people connected to the facility estimated the number to be close to 4,000 patients — in a community with few primary care doctors willing to take on new patients covered by Medicare, federal health insurance for people 65 or older and certain younger people with disabilities.

In the wake of that announcement, other Anchorage providers who do accept Medicare say they're doing their best to respond to what they describe as an overwhelming increase in appointment requests from new patients. Many practices are reluctant to accept more than a few patients covered by Medicare due to low reimbursement rates, which are federally set, advocates say.

Meanwhile, some older patients say they're spending hours calling dozens of primary care providers just to find one accepting their insurance who are also taking new patients.

A handful of providers including Capstone, Providence Alaska Primary Care and Anchorage Neighborhood Health Center who are accepting new Medicare patients said they're experiencing a deluge of calls for appointments. The Anchorage Health Department is forming a task force to help address the lack of primary care options for older patients.

Advocates say they're worried that displaced Regional patients who can't find providers may end up in the emergency room.

Heavy call volumes, new hires

Call volume has nearly tripled in recent weeks at Providence's four primary care clinics in Anchorage, where staff are hiring a new physician to help meet the increased demand for care, according to Tamara Brown, CEO for Providence Clinical Network's Alaska region. Four more provider positions are slated to be filled in the coming months.

Staff at Anchorage Neighborhood Health Center are fielding rising numbers of calls from older patients urgently seeking new providers, said Shannon Savage, the center's chief communications and development director. Savage said she spent a week reaching out to other Anchorage medical offices to see who was accepting new Medicare patients when she found out the Alaska Regional clinic was closing.

What she found was just a handful of Medicare providers to take up the slack.

Besides Anchorage Neighborhood Health, which is a federally qualified health center, and the four Providence Alaska primary clinics — which don't limit the number of Medicare patients they can accept— Capstone Clinics in Anchorage and Mat-Su are also taking new Medicare patients, Savage said. The Anchorage VA Medical Center in Muldoon sees older patients with military connections. A few physicians in private practice are taking on former Regional patients on a case-by-case basis.

Capstone typically tries to cap its patient percentage of "government payers" — which includes Medicare and Medicaid — to around 30 or 40%, according to CEO Dennis Spencer. But increasing demand in recent months prompted the decision to lift those limits for now at most of clinics, Spencer said.

"There's not a lot of options for these folks," he said.

One of Capstone's providers in Eagle River, Dr. Heather Jones, described her frustration at being unable to take on new Medicare patients personally even as her clinic fielded calls from older patients looking for care.

"It's exceedingly hard to say no," said Jones, whose panel of close to 2,000 patients is currently full.

Meanwhile, she worries about her patients, her parents, and her own future, she said. "I'll be on Medicare in 15 years, and I would like to know that somebody will see me."

Pushed to the ER

The situation is raising concern that the provider scarcity could strain emergency departments when older patients aren't sure where else to go but don't need that level of care, said Pam Ventgen, executive director of the Alaska State Medical Association.

The ER, Ventgen said, is the least cost-effective type of medical care: an expensive visit for someone who ends up there simply because they don't have a primary care provider.

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An ER visit was a choice Cheryl Chapman said she was forced to make. For over a week in January, Chapman, 76, tried many times to call the Alaska Regional Senior Health Clinic after a sudden onset of illness, including difficulty breathing. She had been a longtime patient there.

"Either the call would not go through, or I would leave a message and nobody would call me back," she said in a recent interview.

The difficulty breathing eventually got so bad that she decided to visit Regional's emergency room. She waited for several hours to be seen by a doctor, Chapman said.

"It was absolutely packed," she said. "There were a lot of people there who were really, really sick."

A few chest X-rays later, Chapman was diagnosed with pneumonia and given antibiotics for her illness. The ER doctor told her to be sure to follow up with her doctor at the Regional clinic.

"He had no idea what was going on over there, and at the time, neither did I," Chapman said. A day later, she received the letter announcing the closure.

Chapman, who typically avoids the ER because she knows how expensive it can be, recently got her bill from the emergency room visit: $5,684.41.

She's since found a new primary care doctor.

The Medicare problem

Providers accepting the displaced older patients say that so far, actual appointment wait times at Anchorage Neighborhood Health, Capstone and Providence for new patients are not unreasonably long: about a month at Providence clinics and a little over a week at the health center. But they're all waiting to see what happens when the Alaska Regional clinic actually closes at month's end.

Health advocates say the situation highlights a concerning lack of primary care options for older patients in Alaska and nationwide, due to a mix of staffing shortages, a growing senior population, and historically low Medicare reimbursement rates that providers say has made it difficult for doctors to accept more than a few Medicare patients at a time.

Alaska's population is on average younger than the U.S. population, but its retirement-age population has grown sharply in recent years, according to state demographic data.

"There's no question that our growing senior population has had a significant impact on the health care industry as a whole by increasing the demand for services," said Marge Stoneking, an advocacy director with AARP Alaska. "So any time a senior-specific provider withdraws from the marketplace, it's going to have a ripple effect across the health care sector."

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Ventgen, with the state medical association, said the problem is ultimately a national one: it has to do with federal Medicare reimbursement rates, which are as low as 37 cents for every dollar of care, making it difficult for many physicians to take on more than a few Medicare patients.

These rates are set by the federal Centers for Medicare and Medicaid Services and subject to congressional oversight. Medicare payment rates to physicians were decreased by 2% in 2023 by CMS, worsening the problem.

Ventgen encouraged frustrated patients to reach out to their state representatives with their stories and concerns about the lack of care options for older patients in Anchorage, and in particular, the low Medicare reimbursement rates.

"They won't listen to doctors, but they'll listen to patients," she said.

The sudden influx of older patients seeking medical care has prompted the Anchorage Health Department to start the process of establishing a community task force, Dr. Michael Savitt, the agency's medical director, said in an email. That may include finding more primary care resources for older patients so they won't need to rely on emergency departments.

"Our seniors are a more vulnerable population with chronic health conditions and specific age related issues," Savitt said. "Medicare is a federal program, but the lack of available care is a local one that we all need to be concerned about."