[Congressional Record Volume 148, Number 67 (Wednesday, May 22, 2002)]
[Senate]
[Pages S4709-S4710]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. CANTWELL:
  S. 2542. A bill to amend title XVIII of the Social Security Act to 
establish a medicare demonstration project under which incentive 
payments are provided in certain areas in order to stabilize, maintain, 
or increase access to primary care services for individuals enrolled 
under part B of such title; to the Committee on Finance.
  Ms. CANTWELL. Mr. President, I rise today to introduce the Medicare 
Incentive Access Act of 2002. I am pleased that Congressman Rick Larsen 
will introduce companion legislation in the U.S. House of 
Representatives.
  As my colleagues may be hearing, Medicare beneficiaries across the 
country are reporting increasing difficulty finding a physician willing 
to accept their Medicare coverage. In fact, according to the American 
Medical Association, nearly 30 percent of family physicians nationwide 
are not accepting new Medicare patients, and 57 percent of Washington 
State physicians are limiting the number or dropping all Medicare 
patients from their practices.
  There is no doubt that we need to reform Medicare, and I am 
particularly concerned with the Medicare physician fee schedule issued 
by the Centers for Medicare and Medicaid Services, CMS. Although CMS 
insists that physician payment rates will increase more than the 
general rate of inflation, I am extremely concerned that any additional 
physician payment reductions may dramatically affect the quality of 
care offered to beneficiaries and further exacerbate the access 
problems so many of our constituents are now facing.
  Unfortunately, there seems to be a prevailing idea that government 
programs should automatically pay less than private insurers for the 
same quality care. I am especially concerned that providers serving a 
disproportionate number of Medicare and Medicaid patients are facing 
unsustainable fee reductions.
  In its March 2002 report, the Medicare Payment Advisory Committee, 
MedPAC, the independent Federal body that advises Congress on Medicare 
payment issues, weighed in on the current Medicare reimbursement rate 
debate. MedPAC observes that ``provider entry and exit data provide 
information regarding adequacy of the current level of payments.''
  Keeping in mind that MedPAC's goal is to ensure that Medicare's 
payment rates cover the costs that efficient providers would incur in 
beneficiaries' care, it is especially important that MedPAC asserts 
that ``evidence of widespread access or quality problems for 
beneficiaries may indicate that Medicare's payment rates are too low.'' 
In fact, MedPAC surveyed physicians nationwide, and found that 45 
percent said that reimbursement levels for their Medicare fee-for-
service patients are a very serious problem.
  Every day I hear from my constituents that they are facing increasing 
difficulty in getting primary care services, and from physicians who 
can no longer afford to take on new Medicare patients.
  One woman in Steilacoom, WA, contacted me about her son, a 
quadriplegic, who was recently informed that the doctor who has been 
treating him for a number of years will no longer be able to take 
Medicare patients.
  Another woman from Lynden, WA, told me that her doctor is leaving his 
practice due to low Medicare reimbursements, her 89-year-old father has 
also been going to this same doctor and now the family cannot find a 
local doctor to take him.
  When another constituent from Tacoma had to move into the city she 
had to call numerous physicians before she found one who would take a 
new Medicare patient.
  One physician in Bellingham wrote me to say that one of his favorite 
patients will no longer see her family practitioner because she has 
Medicare. This doctor writes ``when our seniors feel bad and ashamed 
about going in to see their physicians because their insurance'' 
coverage is Medicare, I think that reflects very poorly on Medicare, 
our government, our government, that runs the program, and, to some 
extent, the caregivers who feel it is a financial burden to take care 
of our seniors. I couldn't agree more.
  In fact, according to the Washington State Department of Health, in 
Clallam and Kittitas counties in my home State, only 20 percent of 
primary care physicians reported that they would take new Medicare 
patients. Yet, at the same time, most practices are accepting new 
patients with private employer-sponsored insurance. This suggests that 
general physician shortages are not the major cause underlying the fact 
that so many physician practices are closing or closed to Medicare 
patients.
  I understand that there are basic fairness issues involved in the 
national debate over Medicare reimbursements. I am not pretending that 
the Senate will comprehensively address geographic differences or 
payment inequities this session. But I do believe we can look at more 
targeted, limited solutions to address the Medicare reimbursement and 
access issues on a demonstration level.
  We already have a public health program in place, the primary care 
health professional shortage area designation, HPSA, to determine 
whether an area has a critical shortage of physicians available to 
serve the people living there. In fact, this is the measurement used in 
placing National Health Service Corps doctors in underserved areas.
  A HPSA can be a distinct geographic area, such as a county, or a 
specific population group within the area, such as the low-income. 
However, in many shortage locations, access to care is a problem for 
only part of the population. For example, while most residents in a 
city may have adequate access to care, the elderly or poor may not. And 
while population HPSA designations measure access problems for Medicaid 
and low-income patients, migrant workers, and the homeless, there is no 
designation that specifically identifies or addresses Medicare-related 
demographics. My bill changes that.
  The bill I am introducing today, the Medicare Incentive Access Act, 
will create a new Medicare Health Professional Shortage Area, HPSA, 
through a three-year, five-state HHS/Medicare demonstration project. 
Primary care doctors in an area designated as a Medicare HPSA will 
receive an automatic 40 percent bonus on all of their Medicare 
billings.
  I believe it is vitally important that the federal government 
systematically examine different provider incentive programs in order 
to stabilize, maintain, and increase quality, efficient primary care 
services for Medicare beneficiaries. I want this demonstration program 
to examine how we can specifically preserve beneficiary access to 
primary care providers. The demonstration project will also examine 
what level of incentive is necessary to prevent future access problems.
  I want to point out that while current law prohibits multiple HPSA 
designations, the demonstration project will not affect current HPSA 
designations needed for other programs, such as Community Health 
Centers. In addition, physicians in states participating in the 
Medicare HPSA demonstration project will not be able also to receive 
payments under the Medicare Incentive Payment program, which bases its 
ten percent bonus on geographic shortage areas. As I mentioned earlier, 
geographic shortage areas actually have nothing to do with measuring 
Medicare-related access issues.
  There is an abundance of excellent research currently underway at the 
six Federal rural health research centers on all Medicare provider 
reimbursement issues. These research centers are already set up for 
demonstration analyses like the one required under my bill. I sincerely 
appreciate the help Gary Hart, Ph.D. has provided me in developing this 
proposal and discussing other, more comprehensive, means by which to 
look at different Medicare payment and access issues. Dr. Hart is the 
director of the WWAMI Rural Health Research Center at the University of 
Washington, which is largely focusing on rural physician payments.
  I also want to thank Vince Schueler and Laura Olexa of the Office of 
Community and Rural Health and the Washington Department of Health, for 
providing invaluable assistance in understanding rural health problems, 
the

[[Page S4710]]

Federal HPSA designation, and access barriers for Medicare 
beneficiaries, especially in rural areas of the State. After we began 
discussing this problem, they went out of their way to do additional 
surveys in rural counties to measure the most current access to primary 
care physicians for both Medicaid and Medicare patients.
  Finally, I want to thank the Washington State Medical Association and 
Len Eddinger for their advice and assistance on this issue. I am 
delighted that the WSMA has endorsed this legislation, and I ask 
unanimous consent that its letter of support be added in the record at 
the end of my statement.
  The fact of the matter is that there is a crisis at hand regarding 
Medicare benefits, and Medicare payments, and as a country, we simply 
have not invested as we should in health care.
  I sincerely believe that all individuals should have access to 
quality and affordable medical care including the ability to visit 
doctors whom they trust. It will do the country little good to provide 
guaranteed health care for the elderly and disabled if physicians are 
unwilling to work with Medicare patients because of inadequate payment 
policies.
  I believe the bill I am introducing today, the Medicare Incentive 
Act, is a good approach to examining these very important issues. I 
encourage my colleagues to take a look at this bill, and to join me in 
cosponsoring it.
  I ask unanimous consent that a letter of support be printed in the 
Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                         Washington State Medical Association,

                                                     May 13, 2002.
     Hon. Maria Cantwell,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Cantwell: On behalf of the 8,800 members of 
     the Washington State Medical Association (WSMA), please 
     accept my sincere thanks for all the work you are doing to 
     improve the Medicare program.
       The financial condition of the health care delivery system 
     in Washington state is as poor as I have seen in my nearly 25 
     years of practice. As I travel the state and speak with my 
     colleagues, it has become clear that something dramatic and 
     sustainable must be done to ensure the long viability of 
     Medicare and Medicaid.
       At our May Executive Committee meeting, we had an 
     opportunity to discuss the draft of your proposed legislation 
     to develop demonstration projects to enhance physician 
     reimbursement within established Medicare Health Professional 
     Shortage Areas. We view the approach as extremely creative 
     and well worth the time and effort of investigation. Our hope 
     is that successful implementation of this scenario will lead 
     to incentives across the entire physician community.
       Senator, there is no doubt that declining reimbursements in 
     the Medicare and Medicaid programs are putting enormous 
     stress on medical practices and causing physicians to limit 
     patients who are eligible for these programs. We look forward 
     to working with you and your staff to alleviate this pressing 
     social problem.
       Please let us know what we can do to help by contacting Len 
     Eddinger, WSMA's Director of Public Policy, in the Olympia 
     office of the WSMA at (360) 352-4848 or be email: 
     [email protected].
           Sincerely,
                                           Samuel W. Cullison, MD,
                                                        President.
                                 ______