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Medicare Bill Will Increase Payment Fees To California Rural Doctors Recently, Congressman Sam Farr (D-Carmel) introduced a bipartisan bill into legislation, GPCI Justice Act (H.R. 2820), to fix a flaw in the Medicare reimbursements formula affecting doctors and patients in more than a dozen California counties (Congressman Sam Farr) (Library of Congress Thomas). The Centers for Medicare & Medicaid Services’ (CMS) fee schedule is based on geographic designations where rural areas are reimbursed at far lower rates than urban Metropolitan Statistical Areas (MSA’s). In fact, many counties in the rural payment structures areas have not seen a rate increase in 43yrs while MSA’s are increased yearly (California Healthline). Rep. Farr's bill directs CMS to update its geographic designations using Metropolitan Statistical Area (MSA) data. Many counties that are designated as rural in California such as San Diego and Sacramento (California Medical Association), have become more urbanized and more costly to practice in. Therefore, many physicians in California are underpaid. The problem is worsened by the fact that California private payers track Medicare rates. Currently, rurally designated counties are paid 25% less than nearby MSA counties which has led to a loss in both primary and specialty care doctors and effectively devastated Medicare patients’ ability to access health care (California Medical Association). The GPCI bill will ensure that Medicare pays physicians accurately according to their geographic practice costs. It will change the California geographic regions to Metropolitan Statistical Areas (MSA’s) and in doing so, 14 California counties CMS payments would be updated:
Currently, CMS cannot fix the problem in one county without affecting the payment structure in another. Increasing payments to physicians in one region would require CMS to reduce payments in another. To address this, the GPCI bill holds these rural California valley counties immune from cuts up to 5.4% and permanently protects these counties by establishing a payment floor (Santa Cruz County Medical Society). Congress has recognized the importance of HR 2820 as they have tried to address the inequities in the CMS payment structure for rural California in the new health reform bill, HR 3200(Congressman Sam Farr). Concerns for initial drafts of the health reform bill were routed in specific language making payment adjustments to some rural counties. Once the rates were comparable to urban areas, counties would be protected or “Held Harmless” for only five years. Then, these counties would be at risk for potential cuts in reimbursement by 5%. (California Healthline). Physicians in rural California and the valley regions cannot sustain such deep cuts with access to care already suffering in these regions. Elizabeth McNeil, California Medical Association Vice President for Government Relations, states she is, “thrilled the issue has made it to the health care reform bill, but she is concerned about a complex averaging formula which would lower reimbursements to the remaining rural counties rates once the bigger counties move up to urban rates.” (California Healthline). Changes in the CMS payment structure pertaining to rural geographic areas will have an immense impact on the continued ability of health care providers to deliver needed services to Medicare patients. It is important for rural California to be heard on this matter and to influence the language of the health care reform bill in order to better address needed adjustments to the payment structure addressing, protection from cuts in reimbursement rates to any rural California county. CSRHA will be closely watching the progress of the bill and we welcome feedback from our members on this complex issue. Works Cited California Medical Association. “Legislation Introduced to Tackle California’s GPCI Problem, Congressman Sam Farr. “Farr Bill Aims to Correct Medicare Problem.” 11 June 2009. Congressman Sam Farr. “Farr's GPCI Fix Included in Health Reform Bill.” 19 June 2009. Farr, Sam. “GPCI Justice Act of 2009” 11, June 2009. Library of Congress Thomas 7 July 2009. < http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.2820:> Kennedy, Deirdre. “Bill Would Amend Medicare Payment Inequities Among California Santa Cruz County Medical Society. “Locality 99 Solution Proposed by Sam Farr.” No Date. Members Statement 7 July 2009.
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