SIOUX CITY FAMILY PHYSICIANS, P.C.
                            4230 HAMILTON BLVD.
                          SIOUX CITY, IOWA 51104
                         TELEPHONE: (712) 239-4300
JOHN H. ROBERTS, M.D.                                    TERRY H. MITCHELL, M.D.
F. JOHN KISSEL, M.D.                                    THOMAS E. SCHRYVER, M.D.
January 6, 1994

The Honorable Senator Tom Harkin
531 Hart Senate office Building
Washington, D.C. 20510

Dear Senator Harkin,

We are writing to express our concern with the situation in which
we find ourselves relative to the Americans With Disabilities Act
that you sponsored.

We have several deaf patients for which we have been caring for
years, utilizing note pad messages or family member interpreters.
We now find we are mandated to provide interpreter service to deaf
patients. Apparently this is supposed to improve the quality of
medical care.

Our charge for a Medicare patient for a 99213 office visit is
$24.54. Medicare will pay $14.72. We try to collect $4.09 from
the patient if we accept assignment or $9.82 if we don't accept
assignment.

The interpreter charges $15 per hour with a two-hour minimum for
her services. For each visit we are either $5.46 in the hole or
$11.19 in the hole, depending on whether we accept assignment or
not. That is assuming we are able to collect from the patient what
is supposed to be their obligation to pay. We lose money on every
visit.

We never discriminated against deaf people in the past and we saw
them willingly for usual fees.  It frequently took us longer to see
these patients because of the extra time required for waiting notes
back and forth but did not increase our fees because of that.

The squeeze is on in primary care because of Medicare fees being
frozen in 1984 with minimal increases since then and because of
diminishing opportunity to cost shift to other payors. This
kind of mandate by the federal government is grossly unfair. To
require us to bear the burden of the noble idea of having no
discrimination against disabled people makes no sense to us.  We
were doing our share before the law was passed.  You have now made
it onerous to provide the care that we gladly did before.

Please direct your attention to providing some sort of relief for
this problem. Thank you for your consideration.

Sincerely,

John H. Roberts, MD, F. John Kissel, MD  Terry H. Mitchell, MD
01-02998