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Special "News You Can Use" on SGR, GPCI, and ICD-10

Click Here to Read the April 5 U-T San Diego Article Titled: "State Medicare Reimbursements to Rise"

Executive Director Comments:

After almost a decade of struggle, the GPCI inequity for San Diego County is finally resolved — and this is not, repeat not, an April Fool’s joke.

Yesterday evening, the president signed HR 4302 / S 2000, the details of which can be read by clicking here, which does three big things plus a lot of other little stuff that we'll talk about in future NYCUs:

  • kicks the can down the road (for the 17th time, despite a bicameral, bipartisan solution being available) on SGR (precluding the programmed 24% cut in Medicare) for another year (albeit extending the 0.5% increase for the remainder of calendar 2014),
  • pushes ICD-10 implementation to October 2015, and
  • permanently eliminates the geographic inequity for select California urban counties (like San Diego) while holding rural counties harmless — the GPCI inequity!

Why is this a HUGE HUGE HUGE win for San Diego? The Geographic Practice Cost Index (GPCI) annually calculates a county-by-county, cost-of-living adjustor for Medicare. If we were treated as a stand-alone county — like Los Angeles, Orange, San Jose, and San Francisco — we would be in great shape. But we’re not a stand-alone county; San Diego has been lumped in with a number of rural counties, and therefore we are getting less than what we actuarially should, to the tune of roughly $30 million per year for Medicare, and 2-3 times that amount for insurance reimbursements denominated in Medicare rates. The GPCI inequity has cost San Diego physicians roughly $100 million per year for more than a decade.

While in a perfect world the GPCI elimination would have been immediate, in a political compromise the permanent elimination of the GPCI inequity will be phased in over six years, starting in 2017, but the issue has at last been put to rest, allowing us to focus on other issues.

We should all take this opportunity to vociferously thank three people:

  • Dr. Ted Mazer, SDCMS president in 2005-06, and current speaker of the CMA House of Delegates. Over literally a decade, he has unceasingly testified, written, advocated, and pushed for this day.
  • Congressman Darrell Issa (and his staff), who reached across the aisle to make this happen. This was a huge lift, and this would not have happened without Congressman Issa’s leadership.
  • CMA’s lobbying and advocacy team, led by Elizabeth McNeil. She corralled the California delegation into a coherent unit to get a California-only fix into the bill.

For every individual or organizational member of SDCMS-CMA, thanks for your support over the long haul. We literally could not have pulled this off without you.

For every physician who is not a member, you need to join. Today. The increase in Medicare reimbursements and the attendant increases in reimbursements in Medicare-denominated insurances more than pay for your membership — and we need “all hands in” for the MICRA fight.

Join SDCMS-CMA Today by Clicking Here

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