U.S. House to Vote on Bill That Will Improve Payments to Puerto Rico Doctors Under Medicare
Washington, DC—The U.S. House of Representatives is expected to vote this week on a bill that would improve the federal payments made to physicians in Puerto Rico under the Medicare program, Resident Commissioner Pedro Pierluisi announced today. The bill, entitled the Medicare Access and CHIP Reauthorization Act of 2015, would also authorize a two-year extension of the Children's Health Insurance Program (CHIP), under which Puerto Rico receives about $150 million a year. In addition, the bill would authorize new funding for the Community Health Center program. Puerto Rico is home to 67 community health centers—known as “330 centers”—that treat about 340,000 patients annually.
First, the legislation would permanently repeal and replace the “Sustainable Growth Rate” payment formula, known as the SGR, which has been a longstanding problem for physicians in Puerto Rico and the rest of the United States who treat patients enrolled in traditional Medicare. Over the years, Congress has temporarily fixed—or “patched”—the SGR formula 17 times. On April 1st of this year, the current patch will expire, which would result in a 21 percent reduction in payments to doctors under Medicare. This bill would prevent this cut from coming into effect, and would replace the SGR formula with a stable payment system that promotes higher quality care for seniors.
“I strongly support the effort to permanently repeal and replace the flawed SGR formula, which has been the source of considerable anxiety and uncertainty for physicians in Puerto Rico. Doctors deserve a fair and predictable reimbursement system under Medicare,” said Pierluisi.
Second, the legislation contains an important provision that extends—through January 1, 2018—the “Physician Work GPCI Floor,” which prevents a cut of up to 3 percent in the reimbursement rates for doctors in Puerto Rico and certain other U.S. jurisdictions. Pierluisi recently wrote a letter, along with other Members of Congress, urging the inclusion of this provision in the bill.
The federal government calculates payments to physicians through the use of a geographic pricing cost index, GPCI, which is designed to measure how much it costs to practice medicine in different parts of the country. There are three separate GPCIs: Malpractice, Physician Work, and Practice Expense. In the case of all three, the GPCIs calculated for Puerto Rico are the lowest of any jurisdiction in the United States.
“I have been working to ensure that reimbursement rates for Puerto Rico physicians more accurately reflect the actual cost of practicing medicine in Puerto Rico. I have explained to federal officials that many doctors are leaving Puerto Rico and that this exodus owes, at least in part, to the inadequate payments they receive under the Medicare program. Because of these efforts, the federal government has already made an important change to Puerto Rico’s Malpractice GPCI that took effect on January 1, 2014. The agency was using malpractice premium data for Puerto Rico that was more than a decade old. I brought the matter to the agency’s attention, they responded by obtaining more accurate data, and—as a result—Puerto Rico’s Malpractice GPCI was increased by 17 percent,” said Pierluisi.
“We have also achieved a positive result in connection with the Physician Work GPCI. In 2006, Congress established a floor of 1.0 for the Physician Work GPCI, which helped Puerto Rico and certain rural areas in the 50 states whose Physican Work GPCIs would otherwise fall well below 1.0. Since I arrived in Congress in 2009, I have advocated for this floor to be extended, and it has in fact been extended multiple times. The bill to be voted on this week would extend it again, this time through January 2018,” added the Resident Commissioner.
According to calculations, extension of the Physician Work GPCI floor would mean that reimbursement rates for Puerto Rico physicians will be up to 3 percent higher than they would have been if the floor had been allowed to expire.
Third, the bill would provide $7.2 billion for the Community Health Center program nationwide over the next two years.
“Puerto Rico is home to 67 community health centers, in 48 municipalities, operated by 20 non-profit corporations. These centers employ over 2,500 health care workers and treat approximately 340,000 patients a year,” said Pierluisi.
Finally, the bill would extend CHIP, a federal-state program that helps families find health care coverage for their children, through 2017. Funding for CHIP will otherwise expire as of September 30, 2015. Puerto Rico receives CHIP funding as part of its Medicaid program.
“CHIP is very important in Puerto Rico, and so I strongly support its reauthorization by Congress. It is estimated that, in 2015, Puerto Rico will receive about $150 million in CHIP funding from the federal government. Total federal Medicaid funding and CHIP funding for Puerto Rico in 2015 is expected to be $1.3 billion. This is a massive increase over what Puerto Rico was receiving prior to the 2010 Affordable Care Act, but it is still nowhere close to fair, state-like treatment,” said Pierluisi.
If the U.S. House approves the bill later this week, the bill will then be considered by the U.S. Senate.
Legislation will also reauthorize important federal health program for children and fund community health center program
U.S. House to Vote on Bill That Will Improve Payments to Puerto Rico Doctors Under Medicare
First, the legislation would permanently repeal and replace the “Sustainable Growth Rate” payment formula, known as the SGR, which has been a longstanding problem for physicians in Puerto Rico and the rest of the United States who treat patients enrolled in traditional Medicare. Over the years, Congress has temporarily fixed—or “patched”—the SGR formula 17 times. On April 1st of this year, the current patch will expire, which would result in a 21 percent reduction in payments to doctors under Medicare. This bill would prevent this cut from coming into effect, and would replace the SGR formula with a stable payment system that promotes higher quality care for seniors.
“I strongly support the effort to permanently repeal and replace the flawed SGR formula, which has been the source of considerable anxiety and uncertainty for physicians in Puerto Rico. Doctors deserve a fair and predictable reimbursement system under Medicare,” said Pierluisi.
Second, the legislation contains an important provision that extends—through January 1, 2018—the “Physician Work GPCI Floor,” which prevents a cut of up to 3 percent in the reimbursement rates for doctors in Puerto Rico and certain other U.S. jurisdictions. Pierluisi recently wrote a letter, along with other Members of Congress, urging the inclusion of this provision in the bill.
The federal government calculates payments to physicians through the use of a geographic pricing cost index, GPCI, which is designed to measure how much it costs to practice medicine in different parts of the country. There are three separate GPCIs: Malpractice, Physician Work, and Practice Expense. In the case of all three, the GPCIs calculated for Puerto Rico are the lowest of any jurisdiction in the United States.
“I have been working to ensure that reimbursement rates for Puerto Rico physicians more accurately reflect the actual cost of practicing medicine in Puerto Rico. I have explained to federal officials that many doctors are leaving Puerto Rico and that this exodus owes, at least in part, to the inadequate payments they receive under the Medicare program. Because of these efforts, the federal government has already made an important change to Puerto Rico’s Malpractice GPCI that took effect on January 1, 2014. The agency was using malpractice premium data for Puerto Rico that was more than a decade old. I brought the matter to the agency’s attention, they responded by obtaining more accurate data, and—as a result—Puerto Rico’s Malpractice GPCI was increased by 17 percent,” said Pierluisi.
“We have also achieved a positive result in connection with the Physician Work GPCI. In 2006, Congress established a floor of 1.0 for the Physician Work GPCI, which helped Puerto Rico and certain rural areas in the 50 states whose Physican Work GPCIs would otherwise fall well below 1.0. Since I arrived in Congress in 2009, I have advocated for this floor to be extended, and it has in fact been extended multiple times. The bill to be voted on this week would extend it again, this time through January 2018,” added the Resident Commissioner.
According to calculations, extension of the Physician Work GPCI floor would mean that reimbursement rates for Puerto Rico physicians will be up to 3 percent higher than they would have been if the floor had been allowed to expire.
Third, the bill would provide $7.2 billion for the Community Health Center program nationwide over the next two years.
“Puerto Rico is home to 67 community health centers, in 48 municipalities, operated by 20 non-profit corporations. These centers employ over 2,500 health care workers and treat approximately 340,000 patients a year,” said Pierluisi.
Finally, the bill would extend CHIP, a federal-state program that helps families find health care coverage for their children, through 2017. Funding for CHIP will otherwise expire as of September 30, 2015. Puerto Rico receives CHIP funding as part of its Medicaid program.
“CHIP is very important in Puerto Rico, and so I strongly support its reauthorization by Congress. It is estimated that, in 2015, Puerto Rico will receive about $150 million in CHIP funding from the federal government. Total federal Medicaid funding and CHIP funding for Puerto Rico in 2015 is expected to be $1.3 billion. This is a massive increase over what Puerto Rico was receiving prior to the 2010 Affordable Care Act, but it is still nowhere close to fair, state-like treatment,” said Pierluisi.
If the U.S. House approves the bill later this week, the bill will then be considered by the U.S. Senate.
Legislation will also reauthorize important federal health program for children and fund community health center program
U.S. House to Vote on Bill That Will Improve Payments to Puerto Rico Doctors Under Medicare
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