Medicare Pay Equity For "Rural" California Regions


Beginning January 1, 2017 thousands of California doctors will start receiving fee-for-service Medicare pay bumps between 1% and 15%, and that comes on top of any pay adjustments Medicare might otherwise impose.

Encoded in the Protecting Access to Medicare Act of 2014, the Geographic Pricing Cost Index fix is now law. Nicknamed “the GPCI fix,” the correction changes the old, outdated, complex federal formula which has continued to reimbursed doctors in areas that are now urban as if they were still "rural" areas where such costs as hiring office staff, paying rent and buying malpractice insurance is lower.  What this means is that doctors in 15 California counties will now be paid on a scale that reflects a metropolitan rather than rural demographic.

It is estimated the GPCI fix will bring around $52 million a year more to California providers who submit Part B Medicare claims. In San Diego County doctors can expect to get about half of that sum, which works out to a raise of about 1% to 1.5% per year for 6 years.

The  impact is really much greater. "In California all of the private insurance company fee schedules are tied to Medicare's," said Elizabeth McNeil, Vice President, CMA  for Federal Government Relations.

Doctors in these counties will get higher Medicare reimbursement

  • El Dorado
  • Marin*
  • Monterey
  • Placer
  • Riverside
  • Sacramento
  • San Benito
  • San Bernardino
  • San Diego
  • San Joaquin
  • San Luis Obispo
  • Santa Barbara
  • Santa Cruz
  • Sonoma
  • Yolo

Higher physician reimbursement should improve access to health care and shorten appointment wait times for Medicare beneficiaries.

The fix will also raise pay for thousands of healthcare providers who submit Medicare claims, including podiatric physician.

(Source: Cheryl Clark, MedPage Today 3/8/2016)