By Raju Chebium, Gannett Washington Bureau
WASHINGTON -- Doctors who treat Medicare patients in 14 California counties will get paid more by the federal retiree health-insurance program under a bill President Barack Obama signed into law Tuesday.
The measure includes a provision Rep. Sam Farr, D-Carmel, has been pushing for 15 years to increase Medicare reimbursements to doctors in Monterey, Riverside, Sacramento, San Benito, Santa Cruz, Marin, Santa Barbara, San Diego, Sonoma, Placer, El Dorado, Yolo, San Luis Obispo and San Bernardino counties.
Nearly 40 years ago, those counties were classified as "rural" but haven't been upgraded to "urban" despite steady growth in population and the cost of living. Urban doctors get higher reimbursements because of their higher costs of living.
Farr's provision changes the reimbursement formula for those 14 counties so doctors practicing there get paid the same as urban doctors in Los Angeles or San Francisco counties.
The change won't take effect until 2017.
Lower reimbursement rates prompted doctors to turn away Medicare patients or move out of those 14 counties to higher-paying areas, Farr's aides said.
As a result, hundreds of thousands of Medicare recipients had fewer doctors to choose from and sometimes had to travel to neighboring counties for medical care.
Farr said his provision ensures that "a lot of senior citizens who can't get access to medicine . . . will now have doctors."
"There's lot of winners here. The senior citizens win. The doctors win," Farr added in an interview.
The House passed Farr's reimbursement fix three times previously but it never made it through the Senate. This year was different. A Medicare-reform bill that the House approved without taking roll last month included his provision. The Senate passed the House bill on Monday and Obama signed it a day later.
Farr's provision had the backing of Minority Leader Nancy Pelosi, D-San Francisco, and powerful California Republicans like Majority Whip Kevin McCarthy and Rep. Darrell Issa, chairman of the House Oversight and Government Reform Committee.
Other allies included the California Medical Association and the California Hospital Association, or CHA.
Though hospitals aren't affected by the discrepancy in the Medicare reimbursement rates, CHA lobbied for Farr's provision saying the differing rates have ripple effects for the medical profession as a whole.
"Physicians practicing in these misclassified regions are paid as much as 14 percent below what Medicare would pay if they were in a correctly classified region," the group wrote in a letter last year to House leaders. "About a third to one half of the physician groups and hospitals in these regions report difficulty recruiting physicians because the cost of living and the cost to practice are high but the Medicare locality payments have not kept pace with these real costs."
According to the California Healthcare Foundation, the Inland Empire had 40 primary care physicians per 100,000 residents in 2008. Los Angeles County had 58 per 100,000 and the San Francisco Bay area had 78.
Sen. Dianne Feinstein, D-Calif., said she also has been working on changing the outdated formula "that led physicians in counties like San Diego to receive reimbursements at a lower rural rate."
"This bill means that doctors serving Medicare patients throughout the state will receive fair compensation," she said in a statement.
Reimbursements vary for the same type of service from one county to the next. For instance, Santa Cruz County physicians were paid $59.50 per "mid-level" office visit in 2012. But their counterparts in neighboring Santa Clara County got $71.25 for the same type of visit, federal figures show.
The Farr provision is permanent, which means the 14 counties will not revert back to the lower-paying formula after Jan. 1, 2017.
But the bigger Medicare "doc fix" bill that includes his language would give doctors only a year's worth of relief from a 24 percent reduction in reimbursements.
The Associated Press contributed to this story.
Contact Raju Chebium at firstname.lastname@example.org; Twitter: @rchebium