Saturday, December 16, 2017

Dr. Jack Watson, Family Medicine, Santa Cruz

GPCI Fix is Finally In

In 2014, during on one of the most dysfunctional Congresses in history, the CMA won passage of California-only legislation that reformed the outdated California Medicare payment localities and brought substantial payment increases to California physicians. CMA believes it will maintain and improve access to physicians across California.

Over the next decade or so, the new law will provide more than $1 billion in additional payments to California physicians through the Medicare fee-for-service program, Medicare Advantage and private insurer/health plan contracts tied to the Medicare fee schedule. Starting in 2017, the new law phases-in the new payment rates. It will move all California payment localities from a county-based system to a Metropolitan Statistical Area (MSA) based system – just as the hospitals are paid under Medicare. The California localities will be divided into MSAs and physicians paid according to their local costs to provide care. Moreover, the payments will be updated annually to reflect the rise in local practice costs. As you may be aware, the California geographic regions had not been updated by Medicare in nearly two decades and therefore, physicians in 14 California counties were grossly underpaid.

The new law will increase payments up to 14% to physicians in 14 California counties (El Dorado, Marin, Monterey, Placer, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Santa Cruz, Sonoma and Yolo). Moreover, it protects California’s rural physicians as well as Napa and Solano Counties. It establishes a payment floor at 2014 levels so when another recession hits, rural California physicians will not experience a pay cut. Physicians in the existing urban regions will continue to be paid according to their local costs (Alameda/Contra Costa, San Francisco, San Mateo, Santa Clara, Los Angeles, Orange and Ventura).

Read the rest of the article here


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