Mike Abrams, Executive Vice President of the Iowa Medical Society
"I am acutely aware that extending insurance coverage is a hollow victory if there are no facilities and providers available. That's why I will take concrete steps to address this geographic inequity. I will work to fix the historical disparity in Medicare and Medicaid reimbursement rates in which rural providers often get paid less than their urban counterparts when they perform the same procedure." - Barack Obama, in a letter dated October 14, 2008.
Despite those words, which are music to many rural physicians' ears, the executive branch agency in charge of CMS just published a rule (proposed, but not final at this stage) that does the opposite.
Congress (with deep thanks to Senator Grassley, Senator Harkin, and Congressman Braley) passed language that will be very helpful to Iowa's Medicare infrastructure. But what the Congress giveth, the Executive Branch seems determined to taketh away. It is hugely complicated, but suffice it to say that, every three years, CMS is supposed to recalibrate the geographic practice cost indices (GPCIs) - those three annoying knobs CMS turns when they geographically adjust Medicare payment. This is the opportunity for CMS to logically honor the president's commitment. But instead of narrowing the band of disparity, the band is going to widen due to these rules.
[Warning: Sit down before you read this next sentence]
In Iowa, we'll fall from 83rd most screwed of Medicare's 89 payment localities to the 86th most screwed locality, besting only Nebraska, Arkansas, and Puerto Rico. And while I congratulate the five states that jumped the line to get their fix Congressionally-mandated in the health reform bill (remember the frontier states of Wyoming, North Dakota, South Dakota, Montana, and Utah?), I fail to see how CMS can ignore the realities confronting the other states that continue to suffer the huge (and getting more huge instead of less) disparity in Medicare reimbursement.
Iowa Medical Society offered very well-reasoned comments to the agency. Read the IMS letter (PDF 28KB) and see for yourself. These rules are definitely a disappointment, but our IMS staff and leadership will continue to work with our Congressional delegation to pressure the federal government to do the right thing.