Sonoma County Attempts ‘Daunting’ Task of Increasing Medicare Reimbursement Rates
Hospitals and doctors in Sonoma County are seeking increased Medicare reimbursement rates, a "central issue" in the county's "financially wobbly medical community," the Santa Rosa Press-Democrat reports. Medicare insures about 65,000 seniors and people with disabilities in the county, spending about $312 million annually. The Press-Democrat reports that Medicare pays physicians in Sonoma County $51 for an office visit, while doctors in Marin County receive $55 per office visit and those in San Francisco are paid $61. Health care experts in the county say that the "reimbursement disparity" may be causing Sonoma to "los[e] out" on about $38 million. County health officials say that the rates should be increased, because Sonoma County has "one of the fastest growth rates in the Bay area," but is still classified as rural for reimbursement purposes. The Press-Democrat reports that the California Medical Association is "challeng[ing]" HCFA's methodology for calculating the reimbursements.
Dr. Barry Stroube, chief medical officer for the regional HCFA office, said that the payment formulas can be changed in Sonoma County either by decreasing rates in another county, legislating payment increases or waiting until the next formula revision in 2004. Stroube added that any changes before the 2004 revision must be budget-neutral, adding, "If Sonoma County's rates become higher at someone else's expense, then it makes it a political process. You would have to convince people that things are so bad here that it merits taking money away from somewhere else." U.S. Rep. Mike Thompson (D) said that he is working with HCFA, the CMA and local health leaders on the reimbursement "disparities" among counties, adding, "It is not isolated to Sonoma, but endemic in this state and nation. I am trying to persuade my colleagues that this is a national problem that requires national reform" (Rose, Santa Rosa Press-Democrat, 4/8).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.