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| Medicare Change Will Help NM Docs, Patients |
June 20, 2003 |
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Washington, DC - As congressional work to add a prescription drug benefit to Medicare continues, Congresswoman Heather Wilson successfully added to the proposed bill a provision that will level the playing field and equalize payments to doctors in rural states like New Mexico. The potential impact of Wilson`s dealing is $2.5 million a year in our state`s health care system.
"We don`t pay into Medicare based on where we live, and we should not be denied access to health care based on where we live," says Wilson, who increased Medicare Choice reimbursement rates in the 106th Congress and hopes to duplicate that success in another component of Medicare. "Medicare pays a physician less for their time in Albuquerque than they pay in Dade County, Florida or in Manhattan. That`s wrong and it makes it harder to keep doctors in New Mexico."
Wilson inserted the provision during an Energy and Commerce Committee mark-up that spanned three days this week. Wilson`s committee is one of only three in the House and Senate with jurisdiction over the publicly-financed senior healthcare program. Her addition will increase the lower limit of a geographic adjustment formula for physicians` services under the Medicare Program, helping states like New Mexico where the adjuster formula undercuts payments for healthcare services. The formula is used to determine Medicare payments in each of the fifty states.
Wilson`s wants to set a floor of 1.0 in a component of the Medicare geographic adjuster formula for the next two years. This is an enormous victory for New Mexico who`s index is currently 0.973. The provision, a compromise between Wilson and other members of the committee, also includes a study to determine how this unfair payment system impacts areas` ability to attract and retain doctors, and if this should be changed permanently. Wilson thinks that significant differences in physician fees in a national market for health care providers directly creates shortages in some communities like New Mexico, and excesses in other communities with the ability to pay more.
The work component of the "Physician Fee Schedule" measures the doctor`s time, skill and intensity in providing a service. A geographic difference in practice and malpractice reimbursement is logical, since overhead costs like rent, support staff salaries, and insurance can vary throughout the country. But Wilson and medical professionals in New Mexico agree that the value of a doctor`s time and skill should be level nation-wide.
"More than 240,000 New Mexicans rely on Medicare, and most private insurance companies tie their reimbursement rates to what Medicare will pay. Paying doctors more for the same service in other states is one reason why we are losing doctors from New Mexico."
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