Bill would give doctors higher medicare reimbursements

Sonoma County doctors treating Medicare patients would see an extra $5.2 million in their pockets under a bill introduced today in Congress that would revamp Medicare reimbursement rates.

The bill, sponsored by the California Medical Association, would alter reimbursement rates by dumping the “rural and “urban” geographic designations for those cities and counties in Metropolitan Statistical Areas, or MSAs.

The rates, which were to be periodically updated, have not changed since 1997, according to CMA.

Local medical providers have long protested that the rural designation for Sonoma County has short-changed area medical providers because the reimbursement is significantly lower than those of nearby counties, such as Marin, which is designated urban, despite the county’s economic growth and health care costs.

The legislation, introduced in the House of Representatives by Sam Farr, D-Carmel, and in the Senate by Diane Feinstein, D—Calif., would use geographic designations based on Metropolitan Statistical Areas to more accurately calculate health care costs.

“As costs have risen in places like Santa Cruz, Monterey and San Benito counties, Medicare reimbursements have not kept up, and that has resulted in fewer doctors being able to serve those patients,” said Dr. Dev A. GnanaDev, president of the California Medical Association, in a statement.

Tom Mentzer, Congressman Farr’s spokesman, said the bill would be limited to California and would be considered a pilot program. The total cost could be $50 million statewide, based on health care data from 2005, he said.

“The idea is to get this into a larger health care reform bill,” Mentzer said, adding that the estimated $50 million cost would be small compared to the total cost of reforming the country’s health care system.

Santa Rosa attorney Doug Bosco, a former member of Congress who represented the 1st District between 1982 and 1990, said legislation that singles one state out over others usually runs into trouble with other members of Congress.

“Generally, these things don’t get very far,” he said.

But he said that California currently has a great deal of political clout in Washington, with Nancy Pelosi as House Speaker, Sens. Diane Feinstein and Barbara Boxer as senior members.

“If anyone can pull it off, it would be California,” he said.

According to the CMA, the extra $5.2 million Sonoma County doctors would receive represents a 6.2 percent increase over what local doctors are currently getting for treating seniors on Medicare.

But the effects of the bill could be more far-reaching, as private insurer rates are tied to Medicare rates.

Under the bill, California counties would be drawn into their corresponding MSAs. Counties that do not fall into any MSA would remain rural in designation and their reimbursement rates would be unchanged.

Marin County, which is reimbursed under an “urban” designation, would actually get an even better rate because it would be drawn into San Francisco’s MSA.

Aside from those mentioned above, other counties that would see a change in geographic designation include: El Dorado, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Luis Obispo, Santa Barbara and Yolo.