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Geographic Practice Cost Index

Geographic Practice Cost IndexTitle: Geographic Practice Cost IndexWhat problem with Medicare does the GPCI Justice Act, which you introduced earlier this month, address, and how does it aim to help solve it?

GPCI is one of those tricky problems that’s hard to fix because it’s complicated and because it affects a relatively limited area.

The acronym GPCI stands for Geographic Practice Cost Index. Simply put, this index is used to modify Medicare payments to doctors to reflect differences in physician costs in different areas.

This index, established more than 40 years ago, is used to designate counties as either “urban” or “rural,” depending on how expensive it is to operate a practice there.

The problem lies here: although the index was intended to be updated every few years, that hasn’t happened.

That means doctors in counties that were properly designated as “rural” decades ago and have since grown (including San Diego and Santa Cruz counties, to name two) are still labelled “rural” and receive lower payments than doctors in neighboring counties.

Those reimbursement rates are only part of the problem. When doctors aren’t compensated properly for treating Medicare patients, they stop seeing new patients. That means seniors can’t find doctors to treat them.

As many of you know, this has happened right here in Santa Cruz, where doctors have stopped accepting new Medicare patients. To say it’s hard for our seniors to find doctors to see them is an understatement.

I personally find it absolutely unacceptable that an administrative problem in Washington keeps our seniors from receiving care.

My legislation, which was included in the House version of the national health care reform bill introduced last week, would not change those formulas. Instead, it would force the Centers for Medicare and Medicaid Services to update its county designations, as they should already be doing.

If enacted, this means doctors in Santa Cruz would see double-digit increases in reimbursements for treating Medicare patients.

There are a number of additional details that will further improve this reimbursement system. For instance, reimbursement levels are currently based on county data, which is not updated often enough. My language orders CMS to use Metropolitan Statistical Area data. This data is updated annually, is far more accurate and is already used by CMS for hospital reimbursements.

My language also limits this solution to California, which sees by far the most disparities nationwide. I intend California to serve as a pilot program that could then be expanded to other states.

I’ve been working on this issue for several years and we’ve gotten close to fixing it in the past. I’m very hopeful that this provision will remain in the health reform bill as it moves forward. This solution was deemed proper by the Government Accountability Office, the Medicare Payment Advisory Commission and Acumen, a non-partisan policy research organization.

A bill to fix this problem was also introduced in the Senate by Sen. Diane Feinstein, though it has not yet been included in the Senate’s health care reform legislation. I encourage you to call our senators and tell them that fixing California’s GPCI inequities should be a top priority.


Some citizens are concerned about military exercises in the Monterey Bay National Marine Sanctuary. Why are these exercises allowed to be conducted over the Bay, and are there actions being taken to stop them?

My staff spoke with Sanctuary officials who said no new exercises have been taking place in the Sanctuary, so I think callers may be referring either to the ongoing flights that military aircraft conduct or previous plans for amphibious exercises that would have occurred on our Sanctuary beaches.

I would like GT readers to know that I oppose any expansion of military utilization of Sanctuary waters, and I have been very successful in the past in limiting those exercises.

The Marines intended to conduct landing exercises in the Del Monte beach area as part of their amphibious training. After I complained about this plan, it was taken off the table.

We continue to have military planes fly over the Sanctuary on their way south, although those planes follow strict rules on how low they can fly. And in the past, when proposals were brought forward to significantly increase the occurrence of those flights, I was again successful in ending those plans.

I continue to be vocally opposed to any increase in the use of our Sanctuary by the military and I appreciate the concern expressed by your readers.

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