"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.
Sen. Dianne Feinstein said Tuesday there are more "payment inconsistencies" in California than any other state in the country.
"I have been fighting for years to correct the outdated GPCI formula that led physicians in counties like San Diego to receive reimbursements at a lower rural rate," Feinstein said in a statement. "This bill means that doctors serving Medicare patients throughout the state will receive fair compensation."
The new funding formula, which takes effect in 2017, was included in a stopgap bill that delays a 24 percent cut in Medicare payments to doctors for one year. The cuts were scheduled to take effect Tuesday.
Congress has now passed 17 temporary patches to delay the cuts, which are triggered by a 1997 payment formula that ties the budget for Medicare payments to the projected growth of the economy. However, rising health care costs have far outpaced economic growth.
There is widespread agreement in Congress on bipartisan legislation to redesign the payment formula that would give doctors 0.5 percent annual fee increases and implement changes aimed at giving doctors incentives to provide less costly care. But there's no agreement on how to pay the approximately $140 billion cost of scrapping the old formula, known as the Sustainable Growth Rate, or SGR.
"In March, the whole discussion broke down into partisan politics," said McNeil.
The heavily lobbied bill signed Tuesday by Obama blends $16 billion to address Medicare physicians' payments with about $5 billion more for a variety of other health care provisions, such as higher Medicare payments for hospitals and ambulance rides in rural areas. Manufacturers of certain drugs to treat kidney disease catch a break, as do dialysis providers.
The bill also creates two new mental health grant programs, including $1.1 billion over four years for improvements to community health centers in eight states and $60 million over four years for outpatient treatment for people with serious mental illness.
The bill increases spending by $17 billion over the next three years, offsetting the cost with cuts to health care providers, although half do not appear for 10 years.
The Associated Press contributed to this story.
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