CMA Tells IOM: Protect Seniors' Access to Care
Cost and Risk Factors Must Be Considered When Evaluating Medicare's Effectiveness
Sacramento — To ensure senior citizens get the healthcare they need, no matter what their background or where they live, policymakers must balance concerns about Medicare spending with other factors to accurately ensure access to care, the California Medical Association (CMA) said today in a hearing before the Institute of Medicine.
An independent, nonprofit organization tasked with studying geographic differences in Medicare spending and value of care, the Institute of Medicine (IOM) took comments on the issue in Washington, DC. CMA joined the American College of Physicians as the only two major physician organizations asked to testify.
After studying the issue, IOM will present Congress with a recommendation on how to change the Medicare payment system.
“While Dartmouth Atlas studies show big variations in Medicare spending region to region, they do not adequately weight for other crucial factors that account for these differences, such as costs to practice medicine in different regions and differences in patients’ income levels, ethnicities, and health histories,” said Larry deGhetaldi, MD, who testified on behalf of CMA. “Once you accurately assess risk and cost factors unique to each region, Medicare spending does not differ as much region to region. A failure to do so would compromise access to care for the most vulnerable Medicare patients, low-income beneficiaries.”
For example, deGhetaldi said, Los Angeles County has a high poverty rate and high rents and wages, which all push up the cost of providing healthcare there.
DeGhetaldi also gave examples from his medical group, the Palo Alto Medical Foundation, that could provide models for the federal government to spur physician innovation by offering incentives to reduce unnecessary clinical variation and improve care.
In addition, deGhetaldi called upon the IOM to fix the outdated Medicare physician payment regions that undercut physician payments in several California counties. Seniors struggle to find doctors to treat them in counties such as Santa Cruz, San Diego, and Sacramento counties, which are classified as rural under Medicare and therefore offer physicians low reimbursement rates.
CMA advocates for realigning those counties with hospital payment localities, which more accurately reflect urban and suburban costs.