[Congressional Record Volume 148, Number 112 (Monday, September 9, 2002)]
[Senate]
[Pages S8386-S8387]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER:
  S. 2914. A bill to amend title XVIII of the Social Security Act to 
provide for appropriate incentive payments under the medicare program 
for physicians' services furnished in underserved areas; to the 
Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, today I introduce the Medicare 
Incentive Payment Program Refinement Act of 2002. This bill makes 
needed and long-overdue changes to the Medicare Inventive Payment 
Program, an initiative conceived to address the growing primary care 
physician shortage in some of our country's most medically underserved 
communities. The number of physicians needed to care for all 
individuals, especially our aging seniors, continues to grow in remote 
rural areas and in underserved urban areas. However, rising health 
costs and the difficulties of operating a practice in underserved 
communities has exacerbated the physician shortage. Although the 
Medicare Incentive Payment Program aims to address the financial 
hurdles facing physicians in needy areas, the program has failed to 
achieve real results. This bill will make fundamental changes to 
improve the program's effectiveness.
  Rural areas, in particular, are in need of efforts to retain primary 
care physicians, since the difficulties of operating a practice often 
drive doctors to larger areas with more resources and professional 
support. According to the Federal Office of Rural Health Policy, over 
20 million Americans live in areas that have a shortage of physicians, 
and between 1975 and 1995 the smallest counties in the U.S., population 
under 2,500, experienced a drop in their physician-to-population ratio. 
More than 2,200 primary care physicians would be needed to remove all 
nonmetropolitan HPSA designations, and more than twice that number is 
needed to achieve adequate physician staffing levels nationwide.
  According to the National Rural Health Association, nonmetropolitan 
physicians treat a larger number of Medicare and Medicaid beneficiaries 
than their urban counterparts do, generating less income for physicians 
per patient. Furthermore, nonmetropolitan physicians are less likely to 
perform high cost medical services due to their limited number of 
resources. Understandably, MIPP monies can affect the quality of life 
for rural physicians and help prevent the mass migration of

[[Page S8387]]

needed health care professionals from underserved areas.
  The Medicare Incentive Payment Program, as it exists today, has not 
fulfilled its original mandate, to recruit and retain primary care 
physicians in health professional shortage areas. Passed as part of 
OBRA 87, the program pays all physicians a 10 percent bonus for each 
Medicare recipient they treat. This enhanced reimbursement is meant to 
offset the financial advantage of providing service in more populous 
areas, as well as help physicians with the costs associated with 
operating a practice in an underserved community. Most importantly, the 
program aims to increase health care access for Medicare beneficiaries 
and improve the health of communities overall.
  However, analyses from the Office of the Inspector General of HHS, 
the GAO, and independent health experts confirm that the program is 
unfocused and largely ineffective. All physicians are eligible for 
bonus payments, even when they may not be in short supply. Bonus 
payments are 10 percent, not enough to lure physicians to underserved 
areas, especially if the payment is based on a basic, primary care 
visit. Finally, many physicians do not even know this program exists, 
and those that do are often unsure whether they are delivering care in 
a HPSA and how to bill for the payment appropriately.
  To improve the program, this bill increases the bonus payment from 10 
percent to 20 percent and allows only those physicians providing 
primary care services, including family and general medicine, general 
internal medicine, pediatrics, obstetrics and gynecology, emergency 
medicine, and general surgery, to receive the incentive payment. 
Finally, my bill automates payments, so physicians no longer have to 
guess whether they are eligible for the program. These improvements 
will strengthen the original intent of the legislation, to recruit and 
retain primary care physicians in underserved areas, and strengthen the 
primary health care infrastructure of our country's most needy 
communities.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:
       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Incentive Payment 
     Program Refinement Act of 2002''.

     SEC. 2. REVISION OF INCENTIVE PAYMENTS FOR PHYSICIANS' 
                   SERVICES FURNISHED IN UNDERSERVED AREAS.

       (a) In General.--Section 1833(m) of the Social Security Act 
     (42 U.S.C. 1395l(m)) is amended to read as follows:
       ``(m) Incentive Payments for Physicians' Services Furnished 
     in Underserved Areas.--
       ``(1) In general.--In the case of physicians' services 
     furnished by a physician with an applicable physician 
     specialty to an individual who is enrolled under this part 
     and who incurs expenses for such services in an area that is 
     designated under section 332(a)(1)(A) of the Public Health 
     Service Act as a health professional shortage area, in 
     addition to the amount otherwise paid under this part, there 
     also shall be paid to the physician (or to an employer or 
     facility in the cases described in clause (A) of section 
     1842(b)(6)) (on a quarterly basis) from the Federal 
     Supplementary Medical Insurance Trust Fund, an amount equal 
     to 20 percent of the payment amount for the service under 
     this part.
       ``(2) Applicable physician specialty defined.--In this 
     subsection, the term `applicable physician specialty' means, 
     with respect to a physician, the primary specialty of that 
     physician if the specialty is one of the following:
       ``(A) General practice.
       ``(B) Family practice.
       ``(C) Pediatric medicine.
       ``(D) General internal medicine.
       ``(E) Obstetrics and gynecology.
       ``(F) General surgery.
       ``(G) Emergency medicine.
       ``(3) Automation of incentive payments.--The Secretary 
     shall establish procedures under which the Secretary shall 
     automatically make the payments required to be made under 
     paragraph (1) to each physician who is entitled to receive 
     such a payment. Such procedures shall not require the 
     physician furnishing the service to be responsible for 
     determining when a payment is required to be made under that 
     paragraph.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to services furnished on or after 
     January 1, 2003, in an area designated under section 
     332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 
     254e(a)(1)(A)) as a health professional shortage area.
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