By Dan Shingler
Tribune Reporter

Health care providers in rural New Mexico, along with the residents who count on them, stand to benefit from Congress's pending Medicare overhaul.

Both the House and Senate versions of the proposed legislation contain language that would close the gap between reimbursement rates for doctors in rural and urban areas, lawmakers and their aides contend.

Medicare bases its reimbursement schedules, in part, on local wages and costs of living. That translates into lower reimbursement rates for health care providers in rural areas.

U.S. Rep. Steve Pearce, a Hobbs Republican, said he hopes the House will vote this week on its version of the bill. Pearce said the House version of the bill would provide $27 billion to rural health care providers nationwide during the next 10 years - including $15.5 million in increased annual payments to 12 rural hospitals in New Mexico.

Sen. Jeff Bingaman, a Silver City Democrat who sits on the Senate Finance Committee overseeing Medicare and Medicaid, also is working on provisions that would increase Medicare payments in rural areas.

According to a news release from Bingaman's office, the Senate's version of Medicare overhaul would increase reimbursements to rural New Mexico physicians by $2.9 million annually.

Felipe Mendoza, a spokesman for Bingaman, said the Senate is hoping to vote on its version of the legislation this week as well.

All states have rural physicians and hospitals who would benefit from the provisions, assuming they remain in the final legislation. But New Mexico in particular stands to gain because of its largely rural setting.

"We're the ones who see our physicians moving across state lines because they're compensated differently in urban areas," Pearce said.

Pearce said he hopes the changes will help New Mexico recruit and retain more physicians in small towns.

"I think the reimbursement is going to go up enough that we'll find that doctors are pleased, and if they like living in the state, they're not going to go out of state" because of lower reimbursement rates, Pearce said.

Mary Grealy, president of the Healthcare Leadership Council, based in Washington, D.C., said the provisions in the legislation are "the biggest steps Congress has taken toward trying to equalize payments" between rural and urban providers.

The Healthcare Leadership Council is a coalition of chief executives from health care organizations from around the country.

Grealy said rural doctors are looking for more help than the rural-urban equity provision is likely to provide, but other provisions may also increase their compensation. In particular, she said, a provision in the House bill would provide a 5 percent bonus Medicare payment to physicians working in areas the government deems to be under-served with health care services.

All of the potential provisions are good news to health care providers such as Presbyterian Healthcare services, which has substantial rural operations, said spokesman Todd Sandman.

Though its headquarters are in Albuquerque, Presbyterian has hospitals in Ruidoso, Socorro, Tucumcari, Espa§ola and Clovis.

Sandman said Presbyterian is optimistic the proposed Medicare changes will help it financially, as well as make it easier to recruit and retain physicians to its rural hospitals.

Sandman said that in the past, some Medicare reimbursement formulas made no sense.

"The cost of an MRI is the same, and an MRI takes the same amount of time and the same amount of care in a rural area as it does in an urban area," Sandman said.

Changes in Medicare are likely to have other effects, Sandman said, in part because many health insurance providers in the private sector base their payment schedules on those used by Medicare.

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