Representatives and Local Health Care Officials Urge Change in Re-imbursement System to Sonoma County

Santa Rosa, CA – Representatives Lynn Woolsey (D-Petaluma) and Mike Thompson (D-Napa Valley), working together to make health care delivery more efficient and affordable in Sonoma County, today welcomed Mr. Tom Scully, the Administrator for the Centers for Medicare and Medicaid Services (CMS). Along with Sonoma County physicians and hospital administrators, today’s meeting focused on ways to increase payments to Sonoma’s health providers as well as a proposal to streamline emergency room care.

Under the current Medicare structure, a formula known as the Geographic Practice Cost Index (GPCI) adjusts the payment rates healthcare providers receive based on local geographic market conditions. In the subsequent years since this system has been implemented, payments to providers in Sonoma County have not increased relative to changes in the cost of living. Instead, Sonoma County re-imbursement rates remain over nine percent lower than those of counties with comparable costs of living.

Failure to reclassify Sonoma County to mirror neighboring counties could compromise the quality of care and restrict residents’ access to local health care providers. Both Woolsey and Thompson have been working closely with local health care officials and CMS to reconcile this problem. Representatives Woolsey and Thompson requested Mr. Scully’s presence at today’s meeting to help foster discussion between national and regional CMS officials and local doctors who are experiencing first-hand the difficulties of providing health care under these unfair and incorrect reimbursement system rules.”

“Administrator Scully's visit is part of a two-year dialogue concerning inadequate reimbursement rates in Sonoma County,” said Rep. Woolsey. “It is clear from this meeting that our reimbursement rates are too low. We are counting on Mr. Scully to work with us to explore all possible solutions.”

“Sonoma County faces a unique set of problems impacting health care delivery to all residents,” Thompson said. “I am very appreciative of Mr. Scully taking time to meet with our local doctors and hospital administrators to try and resolve this issue. Today’s meeting provided the first steps toward a resolution.”

Also discussed at today’s meeting was a proposal by the Sonoma Healthcare Alliance to institute an emergency care pilot program developed by CMS. Sonoma County health officials and emergency medical personnel discussed the possibility of streamlining existing requirements so that non-critical patients seeking treatment could receive care in a non-emergency setting. This would involve slight alterations to the Emergency Medical Treatment and Active Labor Act (EMTAL), a statute governing when and how patients can be refused treatment or transferred from one hospital to another.