On Monday, I reported on a little-known rule that local doctors say under-compensates them under the federal Medicare program.
The rule is used by the federal government to adjust the reimbursements to physicians under the health care program for seniors to take into account regional costs of running a medical practice. The current formula lumps San Diego with the rural counties in the state, which local doctors say has meant that they were underpaid more than $30 million last year.
In his state of the county address on Tuesday night, county Supervisor Ron Roberts said getting this formula changed was one of his top priorities this year.
Today, I got a chance to talk to two officials the Centers for Medicare & Medicaid Services, the federal agency that administers the health care program. They said the department is currently studying potential revisions to the rule. Both spoke under the condition of anonymity because no proposal has yet been finalized.
The problem — at least what local doctors see as the problem — is that the federal formulas were set 10 years ago and don’t take into account the changes in the costs of operating a business because of things like the California real estate boom. The government hasn’t updated the formulas since then.
Is it now time to do that? Here is what one of the officials said:
That’s been sort of the question that lots of people have asked us. It’s something we’re considering, and how best to do this. Any changes we make would have to made in a budget neutral, zero-sum fashion. Whenever we make changes, there are always winners and losers.
In other words, for San Diego to get more money, some other county would have to get less than it currently receives.
The officials said CMS could make the change administratively, without Congressional approval, though the entire process would take many months to complete — if the agency decides to go ahead with the changes.