[Congressional Record (Bound Edition), Volume 147 (2001), Part 16]
[Senate]
[Pages 22682-22683]
[From the U.S. Government Publishing Office, www.gpo.gov]



 RECLASSIFICATION OF SCRANTON-WILKES BARRE-HAZELTON, WILLIAMSPORT, AND 
                 SHARON METROPOLITAN STATISTICAL AREAS

  Mr. SPECTER. Mr. President, on another subject of great importance to 
Pennsylvania, on two amendments which I am considering offering on the 
stimulus bill, one relates to the reclassification of the Scranton-
Wilkes Barre-Hazelton metropolitan statistical area and also the 
reclassification of the Williamsport metropolitan statistical area, and 
the reclassification of the Sharon metropolitan statistical area. These 
areas' hospitals are in dire straits because the Medicare reimbursement 
formulas allow them less compensation than that to which they should be 
entitled.
  This matter was considered near the end of the last Congress, and 
there were quite a few areas which wanted to have a reclassification. 
All were omitted. The pain for these areas in my State has become more 
intense. An appropriate vehicle would be the stimulus package because 
these reimbursement shortfalls have a direct bearing on the economies 
of these three very important areas.
  There has been a great problem which has resulted from the Balanced 
Budget Act of 1997, and these areas have a much lower reimbursement 
rate than adjacent areas. For example, if you take the Scranton-Wilkes 
Barre-Hazelton area, they receive $6,010 in Medicare payments per case 
compared to Monroe County, an adjacent county, which receives $7,390, 
more than $1,380 more, an enormous differential.
  What is the result? The nurses and the medical personnel go from one 
area to the higher paid area. The Allentown area, again adjacent, 
receives $6,665 compared to the $6,010 for the Scranton-Wilkes Barre-
Hazelton area. The Williamsport area, which is in the same region, is 
similarly disadvantaged, and so is Sharon, PA.
  I ask unanimous consent that a 2-page summary on reclassification of 
these areas be printed in the Congressional Record since there is 
relatively little time remaining, and the summary will explain in some 
greater detail the reasons, and also a copy of the proposed amendment 
which Senator Santorum and I are considering offering when the stimulus 
package comes before the Senate.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 Reclassification of Scranton-Wilkes Barre-Hazleton, Williamsport, and 
                 Sharon Metropolitan Statistical Areas

       Many of Northeastern Pennsylvania's hospitals faced 
     operating losses over the last few years, a troubling reality 
     felt all across the country. In addition, the area is one of 
     the most aged communities in the country, therefore the 
     region's hospitals are extremely dependent on Medicare 
     reimbursement.
       The region has also seen one of the most rapid and dramatic 
     shifts to managed care in the country: over the last five 
     years, managed care grew from virtually no presence to almost 
     50% of the commercially insured population and 20% of the 
     Medicare population.
       While virtually no hospital in the nation has been left 
     untouched by the cost pressures inflicted by BBA 97 and other 
     factors, hospitals in the Scranton-Wilkes Barre-Hazleton 
     Metropolitan Statistical Area (MSA) and in the Williamsport 
     MSA face a unique situation.
       Both of these MSAs contain areas or border on areas from 
     which Geisinger Medical Center, a 437 bed teaching hospital 
     in Montour County, Pennsylvania, draws its patients--and more 
     importantly, its workforce.
       Due to the understandably high wage costs of operating its 
     large tertiary care facility, Geisinger has been reclassified 
     to be deemed part of the Harrisburg MSA. (Its original 
     classification was part of the rural area of Pennsylvania.)
       Therefore, Geisinger Medical Center is being reimbursed 
     based on a wage index that is currently more than 12% higher 
     than the wage indexes of the Scranton-Wilkes Barre-Hazleton 
     MSA and the Williamsport MSA. This results in unsustainably 
     low Medicare reimbursements within those MSAs, particularly 
     since the costs of living are similar to those in Geisinger's 
     area.
       From 11/13/01 Citizen's Voice (Hospitals' Numbers): 
     Medicare Payment per case in Scranton/Wilkes-Barre/Hazleton--
     $6,010--compared to: Monroe County: $7,390; Allentown: 
     $6,665; and Harrisburg: $6,359.
       The Scranton-Wilkes Barre MSA wage index has been steadily 
     falling, reduced from 0.8578 last fiscal year to 0.8473. The 
     actual wage index for the area is around 0.80, but federal 
     law does not permit an MSA to go below the state's rural 
     rate, which will be 0.8473.
       Nursing Shortages Intensifies: the Hospital Association of 
     PA has identified Northeast PA as the area in the state with 
     the worst shortage of nurses. Moreover, other skilled care 
     givers remain in very short supply. These shortages drive up 
     the cost of health care and the need to increase wages--
     something which these hospitals have done.
       Sharon, PA, in the Northwestern part of Pennsylvania, faces 
     similar difficulty hiring skilled workers, due to an 
     unacceptably low reimbursement rate and its need to compete 
     with bordering areas which qualify for higher wage indices.

[[Page 22683]]

       Sharon Regional Medical Center, UPMC Horizon and United 
     Community Hospital are located in the Sharon MSA. Sharon 
     Regional Medical Center is 1 mile from the Ohio border and 12 
     miles from Youngstown, OH.
       However, further reductions in the wage index will make it 
     impossible for the hospitals to retain or recruit all the 
     caregivers that the communities require. Nearby regions, 
     including Newburgh, Allentown and Harrisburg, continue the 
     Scranton skilled workforce. For Sharon, it must compete with 
     the Erie area to the North and Youngstown to the West.
       All of the hospitals in the Sharon MSA compete with 
     Youngstown for nurses, pharmacists, radiology technicians, 
     and other allied health professionals. Youngstown pays nurses 
     $2-$3 more per hour than hospitals in Sharon, yet those 
     hospitals receive nearly the lowest area wage index in 
     Pennsylvania (.850). Youngstown is a larger city/region with 
     a much higher area wage index.
       An MSA reclassification for Sharon, PA is crucial if its 
     hospitals are to maintain their ability to provide quality 
     health care to its citizens.
       A National Solution is Still Years Away: These hospitals 
     cannot afford to wait for this.
       The amendment we intend to offer seeks to remedy this 
     disparity. Our language would reclassify for a period of 
     three years the Williamsport MSA to the Harrisburg MSA: all 
     of the counties within Scranton-Wilkes Barre-Hazleton MSA 
     into the Newburgh, NY MSA; and the Sharon MSA into 
     Youngstown, OH.
                                  ____



                            amendment no.--

 (Purpose: To provide for the reclassification of certain counties for 
         purposes of reimbursement under the medicare program)

       At the end of title IX, add the following:

     SEC. __. THREE-YEAR RECLASSIFICATION OF CERTAIN COUNTIES FOR 
                   PURPOSES OF REIMBURSEMENT UNDER THE MEDICARE 
                   PROGRAM.

       (a) In General.--Notwithstanding any other provision of 
     law, effective for discharges occurring during fiscal years 
     2002, 2003, and 2004, for purposes of making payments under 
     subsections (d) and (j) of section 1886 of the Social 
     Security Act (42 U.S.C. 1395ww) to hospitals (including 
     rehabilitation hospitals and rehabilitation units under such 
     subsection (j))--
       (1) in Columbia, Lackawanna, Luzerne, Wyoming, and Lycoming 
     Counties, Pennsylvania, such counties are deemed to be 
     located in the Newburgh, New York-PA Metropolitan Statistical 
     Area;
       (2) in Northumberland County, Pennsylvania, such county is 
     deemed to be located in the Harrisburg-Lebanon-Carlisle, 
     Pennsylvania Metropolitan Statistical Area; and
       (3) in Mercer County, Pennsylvania, such county is deemed 
     to be located in the Youngstown-Warren, Ohio Metropolitan 
     Statistical Area.
       (b) Rules.--The reclassifications made under subsection (a) 
     shall be treated as decisions of the Medicare Geographic 
     Classification Review Board under paragraph (10) of section 
     1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)), 
     except that payments shall be made under such section to any 
     hospital reclassified into--
       (1) the Newburgh, New York-PA Metropolitan Statistical Area 
     as of October 1, 2001, as if the counties described in 
     subsection (a)(1) had not been reclassified into such Area 
     under such subsection;
       (2) the Harrisburg-Lebanon-Carlisle, Pennsylvania 
     Metropolitan Statistical Area as of October 1, 2001, as if 
     the county described in subsection (a)(2) had not been 
     reclassified into such Area under such subsection; and
       (3) the Youngstown-Warren, Ohio Metropolitan Statistical 
     Area as of October 1, 2001, as if the county described in 
     subsection (a)(3) had not been reclassified into such Area 
     under such subsection.

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