Sonoma County Might Receive Higher Medicare Reimbursements, CMS Administrator Says
At a two-hour meeting Monday, CMS Administrator Tom Scully said that Sonoma County might receive higher Medicare reimbursements because of the county's elevated housing and living costs, but he added that the reimbursement increase could be several years away, the Santa Rosa Press Democrat reports. The meeting, which was held at Sutter Medical Center in Santa Rosa, was requested by the Sonoma Health Alliance, arranged by Reps. Mike Thompson (D-Calif.) and Lynn Woolsey (D-Calif.) and attended by about 50 doctors, administrators and other health leaders. The alliance contends that lower Medicare reimbursement rates resulting from the county's designation as rural by CMS are the primary cause of the bankruptcy of Health Plan of the Redwoods and several medical groups. Area health leaders also maintain that the lower reimbursement rates in conjunction with high housing and living costs have made it difficult to attract and keep physicians in the area for the past 10 years. County officials estimate that health providers are losing about $8 million in reimbursements because Medicare pays an average of 9% less than it pays providers in Marin or Napa counties, the Press Democrat reports. More importantly, local health officials said, is that most health plans base their reimbursement rates on Medicare rates, which costs providers as much as $30 million.
Scully said that CMS will begin using the 2000 U.S. Census data this year to consider revisions to formulas that determine Medicare reimbursement rates. "You probably seem to be treated unfairly, or I would not hear so much about it," Scully said at the meeting, adding that the reimbursement changes could happen as soon as next year. However, he said that changing the reimbursement rates any sooner is "politically impossible" because it would mean a corresponding decrease in some other area of the state, the Press Democrat reports. In addition, Scully noted that the reimbursement rate changes based on the 1990 U.S. Census did not take effect until 1997. Scully also said that California might be broken up from nine geographical categories for provider reimbursements to 15 categories to accommodate concerns raised by counties like Sonoma. "We know that what we want will never happen immediately," Woolsey said, adding, "But we know there are similar areas in California where high housing costs and high living costs are affecting medical services." Thompson said that the meeting forced Scully "to study what we have been telling him for some time, that we are being under-reimbursed by at least 5%," adding that the reimbursement change "will happen as soon as it can happen" (Rose, Santa Rosa Press Democrat, 8/5).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.