Bills Would Help Resolve Medicare Payment Disparities in CA, But Not Other States

The exact amounts of the annual payment increase are not known, but in 2005 dollars, the 14 counties would receive about $50 million, $17 million of which would go to San Diego County. Physicians in Monterey and Sonoma counties would receive $5.2 million each; Sacramento, $4.7 million; Santa Barbara, $4.1 million; Santa Cruz, $3.8 million; Marin, $3.2 million; Riverside, $1.8 million; and San Bernardino, $1.2 million. The remainder would go to Placer, El Dorado, San Benito, San Luis Obispo, and Yolo Counties.

"Doctors in San Diego and 13 other California have been waiting seven years for this change, to continue providing access to quality of care," says Ted Mazer, a CMA trustee and San Diego otolaryngologist. "Hopefully, Congress will act appropriately and the president will sign this bill."

The disparities are the issue in a long-standing legal complaint that asks for more than a billion in retroactive Medicare payments for physicians in seven California counties. The physicians' attorney, Dario DeGhetaldi, says that his claim is waiting on a decision from an appellate court and is so far unaffected by the new bill.

Although the payment disparities have been an issue for eight years, physicians in underpaid counties were having difficulty being heard, in part because other counties worried they would be penalized with reduced fees.  This bill will not do that, and will require a larger appropriation, Farr says.

Another problem in getting the formula changed is that it is complex. "It's never been well understood in Washington. It's esoteric."

He credited the California Medical Association for bringing all counties together "to the winners and losers together to essentially come up with an agreement that there were inequities that needed to be corrected," he says.