[Congressional Record Volume 149, Number 26 (Wednesday, February 12, 2003)]
[Senate]
[Pages S2360-S2361]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DOMENICI (for himself, Mrs. Lincoln, Mr. Rockefeller, and 
        Mr. Thomas):
  S. 275. A bill to amend title XVIII of the Social Security Act to 
establish a minimum geographic cost-of-practice index value for 
physicians' services furnished under the medicare program of 1; to the 
Committee on Finance.
  Mr. DOMENICI. Mr. President, I rise today with my friends Senator 
Lincoln, Senator Rockefeller, and Senator Thomas to introduce the 
``Medicare Access Equity Act of 2003,'' a bill to address the 
inequality that exists in Medicare reimbursement levels to urban and 
rural physicians.
  Nothing is more important to our families than accessible and 
available health care. When we become ill and need treatment, we must 
turn to our doctors for help. But, imagine this, a hospital filled with 
the latest technology, and no doctors to administer treatment.
  Does this sound ridiculous? It's not. Rural patients often have 
difficulty obtaining timely care due to a shortage of physicians, and, 
the problem I have described is not just occurring in my home State of 
New Mexico, forty-one other States are experiencing similar problems 
because of a common set of rules and procedures.
  In most rural areas, Federal policy undermines a doctor's ability to 
see Medicare patients by establishing disparity in reimbursement 
levels. Rural physicians are among the lowest Medicare dollar 
reimbursement recipients in the country, and I submit that this is the 
reason these areas cannot effectively recruit and retain their 
physicians.
  Medicare payments for physician services are based upon a fee 
schedule, intended to relate payments for a given service to the actual 
resources used in providing that service. One component of this fee 
schedule is ``physician work.'' CMS defines ``physician work'' as the 
amount of time, skill and intensity necessary to provide service.
  Each component of the fee schedule is multiplied by a geographic 
index; designed to adjust for variations in cost. The geographic index 
as it relates to ``physician work'' is lower in rural areas than in 
metropolitan/urban areas. Thus, although rural physicians put in as 
much or even more time, skill, and intensity into their work as 
physicians in metropolitan/urban areas; rural physicians are paid less 
for their work.
  This practice is unfair and it is discriminatory. There is no reason 
doctors in Albuquerque, NM should be paid less for their time than 
doctors in New

[[Page S2361]]

York City. Doctors should be valued equally, irrespective of geography.
  The ``Medicare Access Equity Act of 2003'' fixes this problem. The 
Bill creates a more equitable Medicare reimbursement formula for 
doctors in 56 different fee schedule areas in 42 different States. It 
continues to apply the current formula to determine geographic index as 
it relates to physician work. However, once the calculation has been 
completed, The Secretary will increase the work geographic index to one 
for any locality for which such index is below one. Those fee schedule 
areas that are currently at or above one will not be affected by this 
legislation.
  Our Bill builds upon the simple proposition that increased Medicare 
Physician reimbursements improve patient access to care and the ability 
of states to recruit and retain physicians. If Medicare physician 
reimbursement rates are raised, patients will be the ultimate 
beneficiaries.
  Thank you and I look forward to working with my colleagues Senator 
Lincoln, Senator Rockefeller, and Senator Thomas on this very important 
issue.
  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:

                                 S. 375

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Access Equity Act of 2003''.
       (b) Findings.--Congress makes the following findings:
       (1) Americans have paid taxes in to the medicare program 
     equally across the country and every American should have 
     access to quality health care.
       (2) There is a national market for health care providers.
       (3) Increasingly, private insurance companies tie their 
     reimbursement rates to those paid by medicare.
       (4) The physician fee schedule formula for medicare 
     currently includes several adjustments for variable costs 
     throughout the nation. While it is appropriate for the cost 
     of running a practice to reflect overhead differences, 
     physicians should not be compensated for their time 
     differently based on where they live.
       (5) Medicare beneficiaries pay the same part B premium 
     regardless of location which forces subsidization of higher 
     reimbursement areas by seniors in lower reimbursement areas 
     without any corresponding benefit.
       (6) Areas of the country that currently receive the lowest 
     reimbursement from medicare are often the same areas that are 
     experiencing the greatest shortage of physicians. Attracting 
     more physicians to these areas cannot be achieved without 
     greater equity in medicare reimbursement.

     SEC. 2. ESTABLISHMENT OF FLOOR ON WORK GEOGRAPHIC ADJUSTMENT.

       Section 1848(e)(1) of the Social Security Act (42 U.S.C. 
     1395w-4(e)(1)) is amended by adding at the end the following 
     new subparagraph:
       ``(E) Floor at 1.0 on work geographic indices.--After 
     calculating the work geographic indices in subparagraph 
     (A)(iii), for purposes of payment for services furnished on 
     or after January 1, 2004, the Secretary shall increase the 
     work geographic index to 1.00 for any locality for which such 
     geographic index is less than 1.00.''.

  Mrs. LINCOLN. Mr. President, I am pleased to join my colleague 
Senator Pete Domenici today in introducing the ``Medicare Access Equity 
Act of 2003.''
  This important legislation will significantly help rural physicians 
in Arkansas and across the country keep their doors open to Medicare 
beneficiaries. By correcting a disparity in the Medicare physician fee 
schedule, Medicare will pay rural physicians more fairly for their 
individual effort in treating Medicare patients.
  In my home State of Arkansas, 60 percent of seniors live in rural 
areas. Consequently, Medicare patients make up a large percentage of a 
rural physician's practice.
  It is simply unfair that current Federal policy doesn't value 
physician work in all areas, urban and rural, in the same way. Because 
the component of the fee schedule that relates to physician work is 
multiplied by a geographic indicator adjusting for variants in cost, 
Medicare payment policy devalues the amount of time and skill that 
rural physicians spend in providing medical services.
  I believe that work is work, regardless of where it is performed. It 
takes the same amount of time and skill for a physician in Pea Ridge, 
AR to treat a wound or diagnose a patient as a physician in Los 
Angeles, CA. It is time to correct this inequity.
  The Medicare Access Equity Act does this by revising the geographic 
practice cost indices GPCI, to establish a minimum index of 1 for the 
``physician work'' component. The bill applies the current formula to 
determine physician work GPCIs, but if a GPCI is calculated to be less 
than 1, the Secretary of Health and Human Services will increase it to 
1.
  This is critical to my home State of Arkansas, where the physician 
work GPCI is currently 0.953, the sixth lowest GPCI in the country. 
Increasing Arkansas' work GPCI to 1 will automatically pump more money 
to rural physicians in Arkansas, where many may begin to close their 
doors due to the rising costs of providing health care.
  It is my hope that Senator Domenici and I, with help from the Senate 
Rural Health Caucus, can pass this important legislation as part of any 
Medicare reform we consider this year. Fair reimbursement is key to 
ensuring that rural Americans retain the quality health care they 
receive from their doctors.
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