Medicare proposal impresses lawmakers:tri-state delegation pitches plan in D.C.

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Medicare proposal impresses lawmakers:

tri-state delegation pitches plan in D.C.

By Dave Dreeszen

Sioux City Journal, May 8, 2003

WASHINGTON -- A regional approach may be the right medicine for an ailing Medicare reimbursement system that shortchanges metro Sioux City health care providers, federal lawmakers told local leaders Wednesday.

Tired of waiting for a broad overhaul of Medicare, Siouxland officials propose to designate the metro area as part of Nebraska for reimbursement purposes. That's because the Cornhusker state ranks 24th in Medicare spending, receiving an average of $5,367 per recipient, compared to Iowa's last-in-the-nation $3,414.

House Budget Committee Chairman Jim Nussle, a Republican who represents eastern Iowa's 2nd District, was so impressed with the plan that he jokingly said he may steal it as his own.

"You've got a good idea," Nussle told a group of Siouxlanders during a meeting on Capitol Hill. "Because it doesn't affect the eastern side of the state, we're very jealous of your idea."

Several members of the tri-state congressional delegation also voiced support.

"That makes sense," U.S. Rep. Bill Janklow, South Dakota's lone House member, said after hearing a brief explanation of the plan.

Backers say a regional reimbursement rate is legitimate because Sioux City hospitals and doctors treat a large number of patients from Nebraska and South Dakota, where the average reimbursement is $5,183 per recipient.

"It would at least provide us some help and relief until (lawmakers) overhaul the entire system," Dr. Diane Werth, a cardiologist with Cardiovascular Associates in Sioux City, said.

The tri-state plan would require a waiver from the federal agency that administers the Medicare program. Senate Finance Committee Charles Grassley, R-Iowa, whose panel has jurisdiction over Medicare, said he would make such a request to Health and Human Services Secretary Tommy Thompson if asked by Siouxland officials.

Janklow said he also would be willing to discuss a possible waiver with his close friend Thompson, a former Wisconsin governor who he worked with closely during his days as South Dakota governor.

Though he likes the tri-state idea, Nussle said a system that groups Iowa with other Midwestern states would have broader benefits for states with below-average reimbursement levels.

"Instead of having all of these mini regions, maybe bigger regions would be appropriate," Nussle said.

Grassley said the Medicare issue likely will resonate in the Senate because 30 of the 50 states receive payments below the national average of $5,994 per receipient.

"It's a big thing with a lot of my colleagues, including myself," Grassley said in an interview.

Sen. Tom Harkin, D-Iowa, said he has pushed an approach that would increase spending for low reimbursement states like Iowa at a rate faster than top-tier states. In five to 10 years, that would bring Iowa's average reimbursement up to the national average, he said.

Iowa's entire congressional delegation has made fixing Medicare inequities a priority for this session. House members have said a Medicare reform package set for debate later this month must provide relief to Iowa providers or they won't vote for the overall legislation.

"There's no way I can support anything that doesn't address that issue," 4th District Rep. Tom Latham, a Republican who represented the 5th District prior to realignment of the state's congressional boundaries, said.

In a series of meetings on Capitol Hill this week, local health care providers have emphasized the financial headaches caused by Iowa's last-in-the-nation Medicare ranking.

Peter Makowski, chief executive officer of Mercy Medical Center -- Sioux City, noted Medicare accounts for 54 percent of the hospital's revenue. But because the federal payments fail to cover the actual costs, Mercy is forced to write off 32 cents of every dollar, he said.

"We lose money every time we treat a Medicare patient," Makowski said.

But Janklow pointed out most every Republican and Democrat he has talked to on Capitol Hill has been unsympathetic to the hospitals' arguments, suggesting the institutions were getting by just fine financially.

"Nobody buys the accounting because they know it's not legit," Janklow told Makowski.