Clinic Network Leans Into Medicare Headwinds

ZoomCare is confident that it can make serving Medicare beneficiaries financially sustainable.

While some clinics and physician practices are withdrawing from serving Medicare beneficiaries, Tigard, Oregon-based ZoomCare is doubling down on Medicare services.

The Centers for Medicare & Medicaid Services have been scaling back on reimbursement for Medicare services, most recently implementing a 2.8% reduction in physician reimbursement as part of the 2025 Physician Fee Schedule. Physician reimbursement from Medicare decreased 29% from 2001 to 2024, according to the American Medical Association.

The reimbursement reductions have driven some clinics and physician practices to stop serving Medicare beneficiaries, but ZoomCare is bucking the trend.

The 47-clinic organization launched serving Medicare beneficiaries in December in part because patients demanded it, according to Mark Zeitzer, MD, CMO of ZoomCare.

"As patients aged and entered Medicare, they were frustrated that they could not see us anymore," Zeitzer says. "It was important for us to take on that population and do it in a high-quality, effective, and efficient way."

ZoomCare also took on serving Medicare patients because it strives to work with other healthcare providers in Oregon and Washington, Zeitzer explains.

"Serving Medicare patients fits with our commitment to partnership," Zeitzer says, "we want to work with other healthcare providers."

ZoomCare provides primary care and urgent care. It also has three emergency care clinics and offers specialty care, including dermatology, women's health, mental health, and podiatry.

Investing in technology

In July, the clinic network invested in a new electronic health record, athenaOne, as part of the effort to serve Medicare beneficiaries and to work effectively with other healthcare providers.

"What's important is that our system connects efficiently and effectively with other systems," Zeitzer says. "You cannot operate in a silo."

Additionally, athenaOne is Medicare-certified, which was not the case with the homegrown EHR that ZoomCare had been using since 2006.

"Medicare certification is a difficult and onerous process, so an off-the-shelf solution like athenaOne was helpful to achieve that certification," Zeitzer says. "If we had tried to get Medicare certification with our homegrown EHR, it would have taken about three years."   

Making Medicare services financially sustainable

ZoomCare is confident that it can make serving Medicare patients work financially and sustainably, according to Zeitzer.

"Thousands of people age into Medicare every day—it is an important population," Zeitzer says. "These are often complicated patients, but there are many things we can do to prevent problems down the line and maximize their healthy years."

Managing costs is an essential strategy to serve Medicare beneficiaries, Zeitzer explains.

"We believe that by making healthcare easy and accessible we can reduce costs," Zeitzer says. "By being able to see more Medicare patients and being able to maximize preventative services working with Medicare Advantage contracts, we believe we can serve these patients at a low cost in an efficient and effective way."

Access is pivotal, according to Zeitzer.

"If you can get into your provider, your overall health will be better, you will have less side effects, and you will have lower costs," Zeitzer says. "For example, if you can keep hemoglobin A1C scores low and keep Medicare patients who have diabetes healthier, having more frequent touch points with patients helps to make care cheaper."

Centralizing business functions and clinical services is another way ZoomCare is prepared to serve Medicare beneficiaries, Zeitzer explains.

For example, ZoomCare has a centralized team of nurses that process prior authorizations, and there is always a physician on call to answer questions from doctors and advanced practice providers about complicated cases, Zeitzer says.