A letter that arrived in the mailbox of longtime resident Ron Brown from his medical group last week came as a big surprise, but not the good kind.
He was one of 700 informed by Western Medical Associates that his primary care physician is retiring Nov. 10, and furthermore, that he and others on Medicare will be dropped from the medical group unless they find new insurance.

Medicare, the federal health-care program for the elderly and disabled, is the nation's largest provider of health coverage, but its reimbursement rates have sometimes fallen below doctor expectations.

Now, Brown, 77, and about 100 other Medicare patients in Santa Cruz County who see the retiring Dr. Vernon Loverde risk losing their medical care unless they switch insurance companies.
"I just thought it was a very crude way of informing patients," Brown said. "I thought it was terribly unprofessional."

Western Medical Associates is an independent medical practice with six offices throughout the county. It serves about 50,000 patients.
WMA President Dr. Robert Keet, contacted by the Sentinel on Wednesday, said the medical group is rethinking its decision to drop the Medicare patients.

"The bottom line is that we are going to take care of those patients," Keet said. "There was a bit of confusion over the letter, and we are trying to correct that."
Patients will be informed of the latest decision either in a new letter or by phone, Keet said.

The original letters informed patients that Medicare reimbursement rates and policies have led the 30-physician medical practice to make "very difficult decisions in order to best serve Santa Cruz County and our patients." 
Marvin Labrie, chief executive officer of Physicians Medical Group of Santa Cruz County, said many practices in the county are not taking new Medicare patients because the reimbursement doctors get from the federal government often does not cover the cost of performing the medical service. This has made it difficult for many to find a doctor, he said.

WMA is part of the larger Physicians Medical Group of Santa Cruz County.
Santa Cruz is currently designated as a rural area, and therefore physicians receive payments 20 to 26 percent lower than other areas like Santa Clara or San Mateo counties for the same practice, Labrie said.

"This is not unique to Western Medical Associates, as far as a desire to find an alternative to Medicare," he said.

No other doctors in WMA are considering dropping Medicare patients, Keet said.

WMA recommended in its letter last week that patients consider insurance from Secure Horizons because it's cheaper, it offers better benefits for most seniors and it's locally administered, Labrie said.

However, patients such as Brown don't understand why WMA is promoting another medical plan. The letter he received also had a Secure Horizons flyer attached to it. 

"It irritated me. I thought it was unethical," he said.As a result, Brown has already gotten a different physician."I refuse to go back to a clinic that's acting that way," he said. "They were not thinking of the patient, I think they were very crass and unprofessional."

Keet said a new letter will go out to Dr. Loverde's patients to inform them that WMA is committed to caring for them, and doctors have agreed to work harder within the practice to accommodate them.

But for Brown, he said the damage has been done and it's not correctable.
"I just don't want to be associated with Western Medical Associates," he said. "Maybe I'm getting crotchety and old."