Medicare Area 99

Locality 99 Solution Proposed by Sam Farr

You Can Help!

Senator Dianne Feinstein and Congressman Sam Farr will be introducing the CMA-sponsored Medicare "GPCI" legislation right away. The bill would address the outdated Medicare Geographic Physician Payment Localities. You can contact your Members of Congress ASAP and ask them to be an original cosponsor of the bill before it is introduced. I have also contacted all of the California Congressional offices. 

The bill is entitled, "GPCI Justice." It updates the California localities into Metropolitan Statistical Areas (MSAs) and holds all counties that might experience cuts harmless from a payment reduction. In essence, it establishes a permanent California payment floor.

A sample message that you can send to your Members of Congress (along with their contact information) is at the bottom of this email. The message provides a brief summary of the problem and the provisions in the bill. 

We are using the MSA iterative methodology outlined by Acumen in their recent report to CMS. This methodology transitions counties in California to their Metropolitan Statistical Areas. Congress, MedPAC, GAO and Acumen are all strongly favoring the MSA locality configuration because 1) the GPCI data is MSA driven and therefore, the payment rates are more accurate; 2) the hospitals are paid by Medicare according to MSAs; and 3) Congress is moving to eliminate the Medicare Part A and Part B silos so that physicians can reap some of the hospital savings. Part of that effort requires physicians and hospitals to share the same geographic payment regions. 

Congressman Pete Stark and Congressman Henry Waxman agreed to include this legislation in their Health Reform packages. However, we need every California Representative from the impacted counties to cosponsor the bill to show strong California support to Chairmen Stark and Waxman. 

 If you have any questions, please contact me. If you need emails or contact information, please contact my assistant, Leslie Birnbaum at lbirnbaum@cmanet.org. The timing is urgent. Thank you!

Elizabeth McNeil

Vice President

Federal Government Relations

California Medical Association

(415) 310-2877

Here is a list of lawmakers to whom you should send a letter. Feel free to add others to your own list.

Congressman Sam Farr 

1126 Longworth Building 
Washington, DC 20515
Fax (202) 225-8890 

Web form: http://www.farr.house.gov/index.php?option=com_content&task=view&id=202

Congresswoman Anna Eshoo 

205 Cannon Building

Washington, DC 20515 

Fax (202) 226-3805 

Web form: https://forms.house.gov/eshoo/webforms/issue_subscribe.htm

Congressman Pete Stark

239 Cannon Building 

Washington, D.C. 20515 

Fax (202) 225-6791

Web form: https://forms.house.gov/stark/webforms/contact.htm

Congressman Henry Waxman 

2204 Rayburn Building 

Washington, D.C. 20515 

Fax (202) 225-4099 

Web form: www.henrywaxman.house.gov/Contact/

Congresswoman Nancy Pelosi

235 Cannon Building 

Washington, DC 20515

Web form: www.house.gov/pelosi/contact/contact.html 

Senator Barbara Boxer

112 Hart Senate Office Building

Washington DC 20510 

Web form:http://boxer.senate.gov/contact/email/policy.cfm 

Senator Dianne Feinstein

331 Hart Senate Office Building

Washington DC 20510 

Web form: http://feinstein.senate.gov/public/index.cfm?FuseAction=ContactUs.EmailMe

Message to be sent to Members of Congress:          GPCI Letter.doc format

DATE

Dear Representative/Senator _____:

The Santa Cruz County Medical Society and the California Medical Association urge you to be an original cosponsor of an important Medicare bill to be introduced by Congressman Sam Farr. Senator Feinstein will be introducing identical legislation in the Senate. 

The bill is titled, "GPCI Justice." It is a bipartisan bill that will address the outdated Medicare Physician Geographic Payment Regions in California. Fixing this problem is a top priority for physicians in California and we will appreciate your immediate support. 

Background

Medicare law adjusts physician payments based on the geographic practice costs in the region in which they practice. For instance, the law provides additional reimbursement in areas where office rents and nursing staff wages are higher. However, Medicare has not updated the geographic payment regions in more than ten years. Many counties in California that were once rural have become more urbanized and costly to practice in, such as San Diego and Sacramento. Therefore, some physicians in California are underpaid according to Medicare's own figures by up to 13% each year. The problem is compounded in California because private payers track Medicare rates.

The Centers for Medicare and Medicaid Services (CMS) has failed to keep the geographic payments and the regions up-to-date. CMS could fix the problem but increasing payments to physicians in some regions would require CMS to reduce payments in other areas. Physicians in rural California and the valley regions would be hit with 5% payment reductions. Physicians in these areas cannot sustain such deep cuts. Access to care is already suffering in these regions.

Access to Care Problems

For instance, in Santa Cruz County, where physicians are underpaid by more than 8%, no medical groups are accepting new Medicare patients. Payment cliffs with San Mateo and Santa Clara encourage physicians to practice over the hill and inland.

The GPCI Justice Legislation Provides

The GPCI bill will ensure that Medicare pays physicians accurately according to their geographic practice costs. It will change the California geographic regions to Metropolitan Statistical Areas (MSAs). Medicare hospitals are paid and geographically organized into MSAs. This approach has been recommended by MedPAC, GAO and others. The bill will provide physicians in 14 California counties updated payments: El Dorado 2.7%, Marin 7.6%, Monterey 6.5%, Placer 2.7%, Riverside 0.7%, Sacramento 2.7%, San Benito 13.2%, San Bernardino 0.7%, San Diego 4%, San Luis Obispo 0.3%, Santa Barbara 4%, Santa Cruz 8.6%, Sonoma 6.2%, and Yolo 2.7%. 

Equally important, it will hold mainly rural and California valley counties harmless from cuts of up to 5.4%. It will permanently protect these counties from cuts by establishing a California payment floor.

The attached chart shows the payment increases by county in the last column. The counties receiving a 0% change are the counties that would not be cut or increased by the bill. Those physician reimbursements will remain the same. 

The bill will require CMS to update the regions every three years. It will only apply to California and will cost approximately $50 million annually.

Sincerely,

YOUR NAME, TITLE

ADDRESS

CITY  ZIP