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Sonoma County doctors cheer Medicare payment fix (w/video)

  • Dr. Robert Heckey, right, examines Don Siler, who is covered by Medicare, at his family practice office in Santa Rosa on Tuesday, April 1, 2014.
    (Christopher Chung/ The Press Democrat)

"It's going to be huge. There's a real problem in Sonoma County. A lot of doctors are not eager to take on new Medicare patients," said Donald Ransom, associated medical director at Sutter Medical Group of the Redwoods.

In many cases, local physicians have stopped taking new Medicare patients, Ransom said. Many of those who do take Medicare are only treating longtime patients who have aged into the Medicare population, he said.

"This will make a huge difference, allowing primary care physicians to be more open and welcoming to new Medicare patients," Ransom said.

The Sonoma County Medical Association has argued that increasing Medicare reimbursements will make it easier for the county to recruit young doctors and retain those who come to the North Coast after completing their medical studies.

Specifically, the legislation alters the county's designation under Medicare's Geographic Practice Cost Index, or GPCI, which previously lumped Sonoma County in with the rest of the state's non-urban counties. That results in much lower Medicare payments to local doctors than to medical professionals in urban counties such as San Francisco and Los Angeles.

The formula had not been changed in decades. Since its creation, Sonoma County has been transformed from a rural county into a metropolitan area with nearly 500,000 residents.

Doctors in Sonoma, Marin and 12 other California counties previously viewed as "rural" areas will now have Medicare payments tied their Metropolitan Statistical Areas (MSAs), the same way Medicare currently pays hospitals. Other counties that will now be paid as MSAs include Sacramento, San Diego, Riverside, San Bernardino, Santa Cruz, Monterey, San Benito, San Luis Obispo, Santa Barbara, El Dorado, Yolo and Placer counties.

"This would adjust their payments up and help them so we can keep doctors in those areas and provide access for seniors in those areas," said Elizabeth McNeil, head of federal government relations for the California Medical Association.

Rep. Mike Thompson, D-St. Helena, who helped lead the legislation through the House of Representatives, said the county's previous designation as a rural area did not accurately reflect the cost of providing care in Sonoma County.

"Sonoma County medical professionals have been paid an inadequate reimbursement rate for years," Thompson said.


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