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| Wilson Works to Increase Medicare Reimbursement Rates |
May 26, 2000 |
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Key House leader pledges to work with Wilson to provide relief for low reimbursement rates that are crippling New Mexico’s health care system
ALBUQUERQUE, NM – Congresswoman Heather Wilson has convinced the chairman of the key House health care committee to increase Medicare reimbursement rates that threaten New Mexico’s health care system. In a letter to Congresswoman Wilson, Chairman of the House Ways & Means Subcommittee on Health Bill Thomas (R-CA) stated, “We need to bring some immediate relief to states like New Mexico, and I think you may have found a way to do it. Let’s work together to get this done.”
After meeting with constituents in April and being convinced that immediate action is needed to avoid a crisis, Wilson began working quietly with Bill Thomas of California. Thomas is Chairman of the House Ways & Means Subcommittee on Health that will be drafting the prescription drug and Medicare bill.
Wilson proposed to Thomas that the upcoming bill on prescription drugs and Medicare reform might include some relief for states like New Mexico that have very low Medicare reimbursement rates. Wilson has proposed that this summer’s legislation:
* increase the Medicare Choice reimbursement rates nationwide. Managed care can bring competition, control costs, and provide choice for seniors, but the reimbursement rates are too low.
* include in the law a way for counties that receive exceptionally low reimbursement rates to appeal or negotiate a higher rate when they can show that their costs exceed the reimbursed amount.
Medicare reimbursement in New Mexico is among the lowest in the country. In New Mexico, the county with the highest reimbursement rate receives $430.44 per person per month for the Medicare Choice program. That compares with $719.23 in Texas, $729.07 in California, $794.02 in Florida and $814.32 in New York. Even compared to neighboring states like Colorado at $603.55 and Arizona at $551.74 New Mexico’s reimbursement rate is woefully inadequate.
“I support the federal lawsuit New Mexico has joined to get treated fairly by the Medicare system, but it may not happen fast enough through the courts,” Wilson said. “We’re losing doctors every month and several HMO’s are considering dropping Medicare Choice all together.” 40,000 New Mexicans are enrolled Medicare Choice.
“I believe we need a way for counties that have very low reimbursement rates to show their actual costs and then appeal the reimbursement or negotiate for a higher reimbursement,” said Wilson. “Our hospitals and HMO’s are losing money and our doctors and nurses are leaving New Mexico. I have heard from constituents who have “lost” their doctor to another state and I have heard from physicians who have become one of three specialists in the state instead of one of fifteen. I supported the Patient’s Bill of Rights, but if you don’t have a doctor in the first place, a Bill of Rights doesn’t matter. We need to fix this.”
“Somebody had to take the lead on this, and Congresswoman Wilson has come forward with a solution to this problem,” said Dr. David Scrase, a specialist in the care of seniors and president of the Presbyterian Healthcare Plan. “This is about making sure that New Mexico’s seniors have the same access to healthcare benefits that seniors in Florida and New York have. Congresswoman Wilson wants to help level the playing field.”
The Medicare Choice rates are set by a formula that looks at the past cost of care in an area and how often seniors use medical care and then expects to force cost savings from that level. This formula discriminates against states that are poor and where people delay getting prompt medical care because of cost, fear, misunderstanding, or habit. The system is set up so that we will never be able to encourage people to be proactive about their healthcare - - particularly preventive health care.
“The formula discriminates against New Mexico,” Wilson said. “We had managed care before other states, so we had already reduced costs. And our senior didn’t use medical care as much as in other states – even when they should have. States that were less efficient got rewarded. It’s not fair to New Mexicans.”
“It seems very inappropriate that New Yorkers should get twice the benefit that New Mexicans receive, especially considering the fact that the increases in health care costs such as drugs, labor, and aging are not geographic issues, but are uniform throughout the country,” says Dr. Martin Hickey, CEO and President of Lovelace Health Systems in Albuquerque. “It is very appropriate that the U.S. Congress immediately take up this issue to remedy this unfair and inappropriate healthcare reimbursement issue for our seniors. I appreciate the fact that Congresswoman Wilson and other legislators are now seriously pursuing this issue.”
Presbyterian’s head official agrees this is a problem. “The economic situation in health care in New Mexico is reaching the level of crisis, for both patients and physicians,” said Jim Hinton, President and CEO of Presbyterian Healthcare Services. “Federal funding for seniors in most New Mexico counties is significantly below almost every other county in the nation. This discriminatory situation is causing physicians to earn less than their colleagues in other states and creating extraordinary losses at the state’s health plans. Most importantly, federal policy is reducing the availability of quality health care for New Mexico’s seniors.”
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