Iowa doctors watch for Medicare equity

Leading doctors in Iowa are waiting to see how Thursday's Senate health reform bill is reconciled with the House bill passed in November, and what they're watching for may surprise you.

The biggest issue for the state is resolving the geographic disparity in Medicare reimbursements, said Dr. Michael Kitchell, a neurologist in Ames and president of the Iowa Medical Society.

The federal government pays 25 percent less for medical procedures in Iowa and other rural states than it pays in states like California, while the cost of practicing medicine in Iowa is just as high as in other states, Kitchell said. The Medicare rate disparity causes doctors to leave the state, he said.

The disparity is addressed in the House version of the health reform bill, thanks to the work of Rep. Bruce Braley, D-Iowa, but not in the Senate version of the bill. The issue will be settled in congressional conference committee, when the House and Senate bills are reconciled.

“We're still a long way from the final bill,” Kitchell said, adding that he has “high expectations” that Sen. Tom Harkin will use his clout to bring geographic equity to Medicare reimbursements. “In the conference committee, our concern is that we do get geographic equity in the Medicare payments.”

Neither the Iowa Medical Society nor the Iowa Health System, which includes St. Luke's Hospital, have taken a position on the so-called public option or the debate over federal funding of insurance plans that pay for abortions.

Less-publicized portions of the health reform bill will have the greatest impact on Iowans, said Sabra Rosener, director of government relations for the Iowa Health System.

“Whether there's a public option or not, we know who's going to take care of those patients. It'll be us,” Rosener said.

Rosener said an important part of the Senate bill, a feature it shares with the House bill, is a proposal to launch pilot programs called accountable care organizations. They are non-profit entities that would coordinate the work of doctors and hospitals with the goal of cutting costs.

Jim Levett, a cardiothoracic surgeon and chief medical officer for Physicians' Clinic of Iowa, said Cedar Rapids is well-positioned to try this type of program. He is glad the Senate bill doesn't include a public option, because he believes the Medicare reimbursement also would apply to a public insurance plan, thus further disadvantaging Iowa when it comes to attracting good doctors.

A piece that's missing from both bills, Levett said, is tort reform. Medical costs go up, he said, because doctors practice defensive medicine. Better protecting doctors from lawsuits could save $200 billion a year, he said.

“I think tort reform should be instituted at a national level,” Levett said.