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Rx: Medicare Reimbursement

OPB | Oct. 26, 2009 9 a.m. | Updated: Sept. 10, 2013 9:04 p.m.

If you are over 65 and looking for a doctor in Oregon, you may have a tough time. That’s because of a federal calculation that reimburses Oregon doctors at a lower rate than most other states for Medicare patients. According to 2008 data, a typical visit was reimbursed at $74.81 in San Francisco, for example, but just $60.26 in Portland (and even lower at $57.11 in the rest of Oregon). The relatively low reimbursement means some doctors choose not to accept Medicare patients. Others decide not to practice in Oregon at all.

But in the move to reshape healthcare in this country, all that may change.

A number of Democratic lawmakers — including Oregonians David Wu, Earl Blumenauer, Peter DeFazio and Kurt Schrader — just reached a deal with the House leadership that would balance out the reimbursement rates across the country.  The new formula would value quality of care, not just quantity of tests and procedures.

Congressman Earl Blumenauer said:

I have been working for years to get the federal government to stop rewarding health care inefficiencies.  These perverse incentives burden people in more efficient, low-cost regions such as Oregon, where we have had to subsidize expensive and unnecessary treatments in high cost regions. At a time when we are working to recover our economy and spur job growth, subsidizing other regions that overspend on care simply isn’t an option. This agreement and the recommendations that will be made by the Institute of Medicine are a significant step in improving care across the nation and reining in costs.

This new pricing mechanism is now planned to be part of the healthcare plan put forward by the House. In the Senate, a measure that would have prevented Medicare payments from going down as of January 1st, was recently voted down.

Are you a Medicare patient? Have you had difficulty getting care? If you are a doctor, what do you think of the current rates for Medicare reimbursement? Do you, or do you not, accept Medicare patients? What would it take for that to change? How should Medicare fit into a new healthcare plan for the country?

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