Ring.

"Hello, my mother is 78 and has pulmonary disease and is on oxygen 24/7. She also has a smattering of old-age conditions, like high blood pressure and arthritis. She's moving to the area to live with me and needs a doctor. Is Dr. Fasano taking new patients?"

"What type of insurance does she have?" asks the woman who answering the phone at New Haven physician Leonard Fasano's office.

"Medicare," I answer.

"Does she have supplemental insurance?"

"I don't know."

"Let me check with the girls who do billing. Hold on."

A couple of minutes later, the receptionist returns. "Dr. Fasano," she says, "is not taking any new Medicare patients."

Click.

I confess. I don't really have an ailing 78-year-old mother on Medicare. I called Fasano's office, and other local doctors' offices, to investigate what appears to be a growing trend: More physicians are refusing to accept new Medicare patients.

The situation is about to get worse. Next year, the federal government is scheduled to slash Medicare payments by 4.3 percent

Compounding the problem is the fact that Medicare recipients are usually elderly with multiple medical problems requiring more attention. And some docs just don't find it lucrative enough to spend the needed amount of time with these patients for the money they receive. The 40-year-old federal program, which insures 42 million elderly and disabled Americans, pays doctors less than many HMOs and other private insurers do.

The problem seems to be greatest for Medicare recipients looking for primary care doc rather than those looking for specialists.

Right now, this growing problem remains under the radar of the general public, even activist groups. That may change with the release of an upcoming study by Yale Medical School researchers, who called 900 docs' offices across the nation at random. According to the researchers' preliminary findings, about 40 percent of the doctors said they would not take new Medicare patients. (Click here to read more about the study.)

I found pretty much the same results in my random survey of nine New Haven-area primary care doctors' offices. A third said they were not taking new Medicare patients.

Cherry-Picking

Doctors like Leonard Fasano have the legal right to refuse new Medicare patients. (Fasano declined repeated requests to be interviewed for this story.) A smaller, but also significant, problem is the practice of "cherry-picking"â€" doctors accepting only the healthiest Medicare patients. According to federal Medicare statute, doctors who are taking new patients can deny those on Medicare, but must deny all of them.

Leo Cooney, who heads the Yale medical study, says it appears that 6 to 7 percent of doctors surveyed may be cherry-picking, although he says his team hasn't finalized its findings yet.

I followed up my calls to local docs with a second call, a week later. "Hello, my father is 66 and in good health," I said this time. "He wants to switch doctors."

I found one case of cherry-picking, the office of an internist in the Naugatuck Valley. When I called a week earlier about an ailing mother on Medicare, the office had said it was not accepting new patients. But the office said yes to the healthy 66-year-old man.

"Basically there is nothing in statute that says a physician must accept a Medicare patient. And there's nothing in the law that regulates how many a physician can accept," notes Roseanne Pawelec, spokesperson for the Boston regional office for the Centers for Medicare & Medicaid Services, a government agency that regulates Medicare. "But there are laws that prohibit a physician from choosing which Medicare patients he will accept, because some have more complex issues."

Political Muscle Needed

While reimbursement for doctors is shrinking, hospitals and nursing homes will actually see an increase in Medicare dollars.

Why?

"My facetious answer is, Who's got the stronger lobby? Who's gotten to members of Congress?" says Vicki Gottlich, , senior policy attorney in the Washington, D.C., office of the Center for Medicare Advocacy, a Boston-based group. She also says the higher hospital payments are an effort to prevent more from closing.

Furthermore, she says, Congress has increased payments to Medicare HMOs but not to doctors taking non-HMO Medicare patients. Most on Medicare don't belong to an HMO, said Gottlich. "The idea is to get more people to go into private HMOs," she said. Again, "My facetious answer is, Who's got the stronger lobby? Who's gotten to members of Congress?"

There is some noise in D.C. about the impending Medicare cuts.

On July 28, Congresswoman Nancy Johnson (R-Conn.) introduced a bill that would do away with the 4.3 percent proposed cut due to take effect next January. She is chair of the House Ways and Means Health Subcommittee. Her proposal calls for a 1.5 percent increase in physician payment by Medicare. It also includes a provision that reduces reimbursement starting in 2008 if doctors fail to report data on the quality of care they provide.

Want to learn more and do something about this issue? Visit these sites:
â--? Centers for Medicare & Medicaid Services
â--? FamiliesUSA
â--? Medicare Information Resource
To get involved in the fight for universal health care, click here.

Related story: Yale Study: We Have a Problem Here