[Congressional Record Volume 148, Number 40 (Friday, April 12, 2002)]
[Extensions of Remarks]
[Pages E507-E508]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     IMPROVING THE MEDICARE SYSTEM

                                 ______
                                 

                          HON. HEATHER WILSON

                             of new mexico

                    in the house of representatives

                        Thursday, April 11, 2002

  Mrs. WILSON of New Mexico. Mr. Speaker, I rise today to introduce 
legislation that will improve equity in the Medicare system and help to 
alleviate the growing problem of physician retention and recruitment in 
many areas.
  The current physician fee schedule for Medicare has several 
components, one of which is a geographic index supposedly to adjust for 
cost differences in different areas. While this makes sense for a 
physician's expenses for office rent and other costs to vary by region, 
the time spent evaluating and treating a patient should not depend on 
where a senior lives.
  My bill equalizes the physician work component of the Medicare 
physician fee schedule. The physician work component measures the 
physician time, skill and intensity in providing a service. Two 
additional components account for practice expense and malpractice 
expense. While practice and malpractice reimbursement should reflect 
differences in geographic costs, significant differences in physician 
fees in a national market for health care providers directly creates 
shortages in some communities like New Mexico, and excesses in other 
communities because they pay more.
  This bill would eliminate the impact of the adjuster on physician pay 
by making it equal across the country. The physician work geographic 
practice cost index (GPCI) for New Mexico is 0.973. Bringing New Mexico 
to a 1.00 geographic adjuster whether through a floor or making all 
physician fees equal would translate into about a $2,592,203 annual 
increase in Medicare payments to New Mexico physicians.
  More and more seniors are learning that their physician has moved to 
a neighboring state because salaries are dramatically higher. New 
Mexicans don't pay into Medicare based on where we live, and we should 
not be denied access to health care because of where we live. Seniors 
in rural areas or ``low cost areas'' have seen increasing numbers of 
doctors leave for higher paying areas. Keeping doctors in rural states 
is extremely difficult because of the pay gap driven by discriminatory 
Medicare reimbursement. The disparities are very large. In 2000, 
average Medicare payments per beneficiary in New Mexico were

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$3,726, while in Texas average payments were $6,539--70 percent more.
  I urge my colleagues, especially those in rural states to consider 
this bill and its intent to bring equity and access to the outdated 
Medicare system.

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