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| Wilson Aims to Boost New Mexico’s Lagging Healthcare System |
April 12, 2002 |
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Legislation equalizes Medicare funding formula for NM docs
Albuquerque, NM-Amidst growing concerns that doctors are fleeing our state for greener pastures, hurting healthcare in New Mexico, Congresswoman Heather Wilson wants to level the playing field and equalize payments to doctors in rural states like New Mexico.
Wilson this week introduced legislation in the U.S. House of Representatives that seeks to equalize payments to doctors throughout the country with the hope of keeping more doctors in New Mexico. Seniors, in particular, are finding more and more that their doctor has moved to a neighboring state because salaries are dramatically higher.
“Seniors in New Mexico didn’t pay any less into Medicare than seniors in New York or California or Texas,” says Wilson, who in the 106th Congress successfully lobbied to increase reimbursement rates for Medicare Choice programs. “Doctors who treat New Mexicans in New Mexico shouldn’t receive less for their work. That does nothing but hurt healthcare in our state, which in turn hurts seniors and everybody who relies on our healthcare system.”
Currently, Medicare payments to doctors are set by a “Physician Fee Schedule” which adjusts payments to medical practitioners based on geography. Based on this formula New Mexico is among the bottom ten states in Medicare reimbursement to doctors. In 2,000, average Medicare payments per beneficiary in New Mexico were $3,726, while in Texas average payments were $6,3539-70% more.
“Seniors, in particular, rely on medical care more than others,” says Wilson. “An archaic formula tells us that a doctor’s time in New Mexico is worth less than elsewhere, and that’s just not true. We need to fix that for New Mexico because that impacts real people, not statistics.”
Wilson’s legislation would eliminate the impact of the adjuster on one portion of the physician pay formula by making the work component equal across the country. The physician work geographic practice cost index (GPCI) for New Mexico is 0.973. Bringing New Mexico to a 1.0 geographic adjuster, whether through a floor or making all doctor fees equal, would equal an annual increase of more than $2.5 million for New Mexico’s healthcare system.
The physician work component of the Medicare physician fee schedule measures the physician’s time, skill and intensity in providing a service. Two additional components account for practice expense and malpractice expense. While practice and malpractice reimbursement should reflect differences in geographic costs, Wilson and medical professionals feel 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 because they pay more.
“We’ve been operating in New Mexico in a crisis mode for quite some time,” says Dr. Michael Freedman, an Albuquerque neurologist who considered leaving New Mexico four years ago, but opted to stay. Freedman now practices medicine at Southwest Medical Associates, an independent physician group of 26 doctors that contracts with area health plans to serve their members.
“We know there isn’t one single cure for our healthcare system, but Congresswoman Wilson’s effort is important to leveling the playing field so that doctors don’t find other states more attractive. Our focus should be on improving patient care. I think her legislation is a step in the right direction at keeping doctors here and attracting more healthcare practitioners to our state. I’m glad Congresswoman Wilson is taking this on,” concluded Freedman.
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