Representative Mike Thompson's Medicare Reimbursement Fix Passes Senate, to Be Signed into Law

Press Release

An effort to fix the out-dated formula used to determine Medicare reimbursement payments that U.S. Rep. Mike Thompson (CA-5) helped lead through the House passed the Senate today as part of H.R. 4302, the Protecting Access to Medicare Act of 2014, and will now go to the President's desk to be signed into law. H.R. 4302 passed the Senate by a bipartisan vote of 64-35.

"This fix will help make sure that medical professionals in Sonoma County who care for Medicare beneficiaries are reimbursed at the appropriate, up-to-date levels," said Thompson. "I am proud to have worked to get this fix signed into law so that we can make sure Sonoma County's medical professionals get reimbursed at levels similar to those in neighboring, urban-classified counties, and so that we can protect and improve access to care."

Currently, Medicare reimburses physicians according to the Geographic Practice Cost Index (GPCI), an index based on cost of living, cost of providing care, cost of malpractice insurance and other provider costs.

Counties in California are put into one of nine separate reimbursement localities based on the GPCI formula. Counties with similar GPCIs are supposed to be put in the same reimbursement locality.

However, Sonoma County, which despite having a high cost of living, is classified as a rural county. Because of this out-dated rural classification, physicians are being reimbursed at a level that doesn't accurately reflect the costs of providing care in that area.

The legislative fix advocated for by Thompson corrects this by updating the outdated payment localities to the current Metropolitan Statistical Areas (MSAs), which is the same way Medicare currently pays hospitals.

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