[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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