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PD Editorial: A Medicare fix in the works for local docs

  • (PAUL TONG / Tribune Content Agency)

Which of these words doesn't fit in a sentence about health insurance?

Arbitrary.

Capricious.

Inexplicable.

Infuriating.

OK, it was a trick question. All too often, any one of those words would fit perfectly — much like two sides of a vise squeezing firmly together against your temples.

Here's a telling — or shall we say arbitrary? — example involving physicians and senior citizens in Sonoma County. Under Medicare's outdated reimbursement system, doctors here are paid substantially less than their counterparts in Napa and Marin counties receive for the same appointment or procedure.

Why? Under Medicare's geographic practice cost index, or GPCI, it's all about location. Doctors in counties designated as rural receive less than doctors in urban counties. Napa and Marin are designated as urban, while Sonoma County, despite its high cost of living and its proximity to the urbanized Bay Area, gets lumped in with California's smallest and most remote counties.

The bottom-line impact on physicians is magnified because many private insurers base their reimbursement rates on what Medicare pays.

Doctors aren't the only ones affected by the rural designation. It's detrimental to patients, too, because low reimbursement rates are a disincentive for Sonoma County doctors to accept Medicare beneficiaries. Furthermore, it complicates efforts to recruit and retain doctors to practice in the county.

We've been writing about this issue for more than a decade, and local doctors have been lobbying even longer, without any success.

Finally, there's some sign of movement.

Legislation approved last month by the House Ways and Means Committee redesignates high-population counties as metropolitan rather than rural.

Sonoma County would benefit from the change. So would Sacramento and San Diego — two counties that probably don't strike many Californians as rural.

The Medicare legislation, authored by Rep. Mike Thompson, D-St. Helena, would increase reimbursement rates in Sonoma County by about 6 percent.

“This fix will make sure Sonoma County's medical professionals get reimbursed at levels similar to those in neighboring, urban-classified counties,” said Thompson, a member of the Ways and Means Committee. “And, it will help protect and improve access to care.”

Thompson's bill could come up for a vote on the House floor this month. Senate approval also is needed to change the reimbursement rates.

Congress had a hard time agreeing on anything in 2013. But this is an election year, and we hope that improves the odds for a measure that stands to benefit physicians and their patients alike.

The present reimbursement system is arbitrary and capricious. Leaving it in place would be, well, inexplicable and infuriating.

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