The largest family practice office in Wyoming might stop seeing Medicaid and Medicare patients starting this fall, its chief executive officer said.

Western Medical Associates CEO Richard Blauvelt sent a letter to the governor's office, the Wyoming Department of Health and others this week explaining how unfair reimbursement rates are hurting doctors.

The practice - which includes six physicians, two physician assistants and a nurse practitioner - will opt out of Medicare Sept. 1 and Medicaid Oct. 1, he wrote.

In an interview Friday, he said the office would stay in the programs if it received help from the state and federal governments.

He also said the office is reviewing other low-reimbursement programs such as TriCare (which serves veterans) and private insurer Blue Cross/Blue Shield.

Blauvelt will meet with people from the health department and the governor's office Monday to discuss possible solutions.

Medicaid offers insurance to low-income people through a joint state and federal effort. The state has little to do with Medicare, a federal program for those 65 and older.

"They want us in the [Medicaid] program bad, and with that attitude, I think we will make it work," Blauvelt said.

Physician reimbursement is a major concern for the health department, said its director, Dr. Brent Sherard.

If something isn't done, he fears more physicians will opt out of the programs, creating an even greater health care access issue in the state.

Between 10,000 and 15,000 of Western Medical Associates' 30,000 patients stand to lose their primary care providers.

"In any business, if your expenses exceed your revenue, you have a problem," Sherard said. "If you called any physician that takes care of Medicaid patients, especially if its a large part of his practice, they will be concerned about this."

The doctors aren't the "bad guys" in this situation, Blauvelt emphasized. He said the doctors care for each patient regardless of what type of insurance they have and "would give you the shirt off their back."

The amount paid by insurer varies. For example, private insurance might pay $100 for a visit, while Medicaid pays $64 and Medicare pays only $32.

Doctors stood to lose even more this past week, but Congress passed a bill Wednesday that stopped a 10.6 percent cut to Medicare reimbursements.

"We're tired of getting threatened every year," Blauvelt said. "If your employer told you he was going to reduce your salary by 5 percent, you wouldn't stay in the system. We're not, either."

Blauvelt said it was "a very economical decision."

He said he is standing up for doctors, whom Blauvelt said usually aren't good business people, to make sure they are treated fairly.

"I've battled this before," Blauvelt said. "I know what's normal in our field, and this is not normal."

During Monday's meeting, Sherard said, he will listen to the practice's concerns, offer suggestions to immediately enhance reimbursements and talk about long-term solutions.

Sherard said many physicians do not take advantage of the Total Health Record program, in which they can receive a higher reimbursement for tracking patients' records; or a high-volume bonus for practices with a significant number of Medicaid patients.

Blauvelt said the state might be able to help teach the practice's doctors how to use specialized medical codes to receive a higher rate of reimbursement.

Blauvelt said he hadn't heard back from the regional Medicare offices, yet.

A spokesman for the Centers for Medicare and Medicaid Services regional office said people in his office hadn't seen the latest letter.

If Western Medical Associates opts out of the two programs, Blauvelt said, the waiting time for patients to schedule appointments with doctors would decrease from three months to about a week.

Also, he said, many of the patients would end up in Wyoming Medical Center's emergency room.

Patients might also go to the Community Health Center of Central Wyoming or other Casper primary care providers, said Mike Phillips, spokesman for the hospital.

"Obviously, if you put an influx of people into the medical community, it's going to put some stress on it," Phillips said.

Sage Medical Group, a primary care practice owned by WMC, accepts all patients regardless of their ability to pay. It's made up of four primary care physicians, and Phillips said the hospital is recruiting more.

The hospital's emergency room is already busy, but Phillips said it would be able to handle more patients if necessary.

"It's why we are expanding, to meet the needs of the community," Phillips said. "We would be able to adjust to that if it happens."

Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@trib.com.