PD Editorial: Absurd rates

We’ve long railed at the unfairness of it all. Sonoma County health care providers — by design — receive Medicare reimbursements that are 8 to 10 percent less than those received by doctors in Marin County and other areas.

The reason is Sonoma County is considered “rural” while Marin qualifies as “urban.”

What’s absurd, however, is that Napa County also qualifies as urban and thus receives the larger reimbursements.

This inequality has been both a thorn in the side of the Sonoma County health care industry for years as well as a stumbling block in efforts to recruit and retain the next generation of health professionals.

In many cases, it also has forced local physicians to refuse to take any more Medicare patients. Low reimbursement rates also were blamed for the 2002 bankruptcy of Health Plan of the Redwoods, the county’s largest HMO at the time.

But a new bill in Congress seeks to level the playing field. The bill, sponsored by the California Medical Association and co-authored by Rep. Sam Farr, D-Carmel, and Sen. Dianne Feinstein, D-Calif., would change reimbursement rates by dumping the “rural” and “urban” designations for those cities and counties in metropolitan areas.

If approved, the bill would mean an extra $5.2 million a year for Sonoma County doctors as well as additional cash for physicians in other “rural” areas, such as Santa Cruz, Monterey and San Benito counties.

This also would likely result in other increases as well since rates set by private insurers are often tied to Medicare reimbursements.

But no one should start counting on that extra income quite yet. This is just the latest in many efforts to fix this problem, and none has been successful so far. Few in Congress are eager to approve a bill that would increase reimbursements for one area — especially in expensive California — without cutting from another.

In addition, sponsors hope to tie this bill to a comprehensive health care reform package, which may take months to get off the ground.

Nevertheless, the issue is getting more attention and there’s reason for optimism.

As experts note, Medicare rates were supposed to be periodically updated. But they haven’t changed since 1997, according to the California Medical Association.

Righting this historic wrong would be a good place to start.