Plan Announced to Correct Local Physician Reimbursement Rates

Plan Announced to Correct Local Physician Reimbursement Rates
August 4, 2005

SANTA ROSA, CA - After over five years of working to change the way that Sonoma County physicians are reimbursed through Medicare, Sonoma County Congressional Representatives Lynn Woolsey (D-Petaluma) and Mike Thompson (D-St. Helena) are pleased to announce a proposed rule change to increase the Medicare reimbursement rate to local physicians. The Center for Medicare and Medicaid Services (CMS) proposed rule change is the first step towards increasing the Medicare reimbursement rate to Sonoma County doctors by 7-10%.

"This is great news for the health care system in Sonoma County," said Rep. Woolsey. "For too many years, Sonoma has been unfairly lumped into Locality 99 which has a reimbursement rate that is far below the cost of doing business for our doctors. While I recognize that the proposed rule change does not solve the reimbursement problem across the board for other counties in California, it goes a long way to ensuring that local doctors can stay in business while caring for the most fragile patients in our community."

"This is a necessary first step to addressing Medicare's physician reimbursement inequity in Sonoma County," Thompson said. "The county's reimbursement rates have been shockingly low. Sonoma County physicians have been fighting for fairness for years and I'm pleased that CMS is beginning to act."

Reps. Woolsey, Thompson and Sam Farr (D-Carmel) successfully included language in the FY05 Labor/Health and Human Services spending bill that codified an understanding reached by the former CMS Administrator Tom Scully at a meeting with Sonoma County physicians arranged by Thompson and Woolsey in 2003. The federal language called for the Center for Medicare and Medicaid Services to present a plan to Congress for fixing a decade old discrepancy in the reimbursement rates paid to doctors in Sonoma and three other California counties.

Physicians have long pointed to the low reimbursement rate in comparison to the high cost of practicing medicine in Sonoma County as one of the chief reasons for doctors leaving the area and for the failure of several medical groups.

The proposed rule change is a restructuring of the geographic payment localities in California. Under the proposed rule change, Sonoma County and Santa Cruz County will be taken out of their current localities and become their own distinct localities.

"Because this is a 'proposed rule,' it is important that CMS hear from our doctors and patients alike before the September 30th deadline," said Rep. Woolsey.

http://woolsey.house.gov/latestnews.asp?ARTICLE5110=43951