Health care industry officials worry that some Medicare costs will rise but hope patients will have greater access to doctors under a new bill that will become law.

   The Medicare Improvements for Patients and Providers Act of 2008, which President Bush vetoed last week but Congress overrode, delays for 18 months a scheduled fee cut to doctors and also affects private insurance plans, mental health benefits and pharmacy drug benefits.

   Reversing the 10.6 percent decrease in physicians' reimbursements that took effect July 1 and a projected 5.4 percent cut in 2009 means seniors entering the system should be able to find doctors that accept Medicare, said John Suits, vice president of business development and advocacy for Memorial Health System, which operates two campuses.

   "We were concerned that if this didn't go through there would be even more practices closed to new Medicare patients," he said, "which would lead to increased utilization of our emergency department for what really should be primary care procedures."

   The legislation also gives the Department of Defense the go-ahead to maintain reimbursements to Tricare physicians, crucial in El Paso County, Suits said, because military members and families already have trouble finding doctors that accept the military's insurance plan. Tricare bases its physician reimbursements on the Medicare fee schedule.

   In order to avoid reduced payments to doctors, more than $12 billion in cuts over five years will be made to private insurance companies that sell alternative plans to traditional Medicare called Medicare Advantage. President Bush cited those cuts in his veto of the bill.

   "Congress had to find the money somewhere, so a portion will come from reduced payments to HMOs, and if HMOs receive smaller federal payments for their products, they either have to reduce benefits or increase premiums to ofier the same type of product," said Jim Hertel, a Denver-based insurance industry expert and publisher of the Colorado Managed Care newsletter.

   Anthem Blue Cross and Blue Shield anticipates increased costs for Medicare recipients who buy its Medicare Advantage plan, said spokeswoman Sally Vogler.

   Anthem's parent company, WellPoint, heavily lobbied against the bill, she said, adding that members will not see effects until 2010. Anthem introduced its Medicare Advantage plan in El Paso and Teller counties this year and has 150 members, Vogler said.

   Decreasing funding for Medicare Advantage means the plans will change, said Anna Hobbs-Little, spokeswoman for Humana, which has 48,231 Medicare members in Colorado. It's too early to know the specifics, she said, but the new law will require by 2011 Medicare Advantage plans to establish provider networks similar to those of HMOs and PPOs. Currently, the plans allow beneficiaries to see any physician willing to accept the payment terms.

   Rocky Mountain Health Plans, a Grand Junctionbased insurer, will benefit from provisions in the bill. The legislation enables Rocky Mountain, and about a dozen other insurers in the nation, to continue a private Medicare plan that is based on a cost rather than a risk model, said Kayla Arnesen, spokeswoman.

   "It's an extremely important piece of legislation to be passed," Arnesen said, "and we're very pleased we'll be able to continue this type of contract and coverage in Colorado because it ofiers a choice."

   The nonprofit Rocky Mountain has 699 Medicare members in El Paso and Teller counties, she said.

   The bill also will allow more seniors to obtain mental health care because it reduces co-payments from 50 percent to 20 percent, which is in line with co-pays for other health services, said Kelly Phillips-Henry, chief operating officer for Pikes Peak Behavioral Health Group.

   Local need for mental health services among Medicare recipients is high, she said, as many seniors and people with disabilities have depression, anxiety disorders and trouble dealing with change.

   The new legislation also will boost payments to doctors who use electronic prescribing, and add certain preventive treatments and drug coverage.

   But Memorial's Suits said the legislation is a Band-Aid, not a cure, for a system that's becoming increasingly taxed by aging baby boomers.

   "Every year we go through this, but it's peace of mind for the next year that access for seniors and the military shouldn't be any more limited than it already is," he said.