MEDICARE INCENTIVE PAYMENT PROGRAM IMPROVEMENTS FOR PHYSICIAN SCARCITY.

SEC. 413. MEDICARE INCENTIVE PAYMENT PROGRAM IMPROVEMENTS FOR PHYSICIAN SCARCITY.(a) Additional Incentive Payment for Certain Physician Scarcity Areas.—Section 1833 (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:“(u) Incentive Payments for Physician Scarcity Areas.—“(1) In general.—In the case of physicians’ services furnished on or after January 1, 2005, and before January 1, 2008—“(A) by a primary care physician in a primary care scarcity county (identified under paragraph (4)); or“(B) by a physician who is not a primary care physician in a specialist care scarcity county (as so identified),in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid an amount equal to 5 percent of the payment amount for the service under this part. “(2) Determination of ratios of physicians to medicare beneficiaries in area.—Based upon available data, the Secretary shall establish for each county or equivalent area in the United States, the following:“(A) Number of physicians practicing in the area.—The number of physicians who furnish physicians’ services in the active practice of medicine or osteopathy in that county or area, other than physicians whose practice is exclusively for the Federal Government, physicians who are retired, or physicians who only provide administrative services. Of such number, the number of such physicians who are—“(i) primary care physicians; or“(ii) physicians who are not primary care physicians.“(B) Number of medicare beneficiaries residing in the area.—The number of individuals who are residing in the county and are entitled to benefits under part A or enrolled under this part, or both (in this subsection referred to as ‘individuals’).“(C) Determination of ratios.—“(i) Primary care ratio.—The ratio (in this paragraph referred to as the ‘primary care ratio’) of the number of primary care physicians (determined under subparagraph (A)(i)), to the number of individuals determined under subparagraph (B).“(ii) Specialist care ratio.—The ratio (in this paragraph referred to as the ‘specialist care ratio’) of the number of other physicians (determined under subparagraph (A)(ii)), to the number of individuals determined under subparagraph (B).“(3) Ranking of counties.—The Secretary shall rank each such county or area based separately on its primary care ratio and its specialist care ratio.“(4) Identification of counties.—“(A) In general.—The Secretary shall identify—“(i) those counties and areas (in this paragraph referred to as ‘primary care scarcity counties’) with the lowest primary care ratios that represent, if each such county or area were weighted by the number 117 STAT. 2276 of individuals determined under paragraph (2)(B), an aggregate total of 20 percent of the total of the individuals determined under such paragraph; and“(ii) those counties and areas (in this subsection referred to as ‘specialist care scarcity counties’) with the lowest specialist care ratios that represent, if each such county or area were weighted by the number of individuals determined under paragraph (2)(B), an aggregate total of 20 percent of the total of the individuals determined under such paragraph.“(B) Periodic revisions.—The Secretary shall periodically revise the counties or areas identified in subparagraph (A) (but not less often than once every three years) unless the Secretary determines that there is no new data available on the number of physicians practicing in the county or area or the number of individuals residing in the county or area, as identified in paragraph (2).“(C) Identification of counties where service is furnished.—For purposes of paying the additional amount specified in paragraph (1), if the Secretary uses the 5-digit postal ZIP Code where the service is furnished, the dominant county of the postal ZIP Code (as determined by the United States Postal Service, or otherwise) shall be used to determine whether the postal ZIP Code is in a scarcity county identified in subparagraph (A) or revised in subparagraph (B).“(D) Judicial review.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—“(i) the identification of a county or area;“(ii) the assignment of a specialty of any physician under this paragraph; “(iii) the assignment of a physician to a county under paragraph (2); or “(iv) the assignment of a postal ZIP Code to a county or other area under this subsection. “(5) Rural census tracts.—To the extent feasible, the Secretary shall treat a rural census tract of a metropolitan statistical area (as determined under the most recent modification of the Goldsmith Modification, originally published in the Federal Register on February 27, 1992 (57 Fed. Reg. 6725)), as an equivalent area for purposes of qualifying as a primary care scarcity county or specialist care scarcity county under this subsection.“(6) Physician Defined.—For purposes of this paragraph, the term ‘physician’ means a physician described in section 1861(r)(1) and the term ‘primary care physician’ means a physician who is identified in the available data as a general practitioner, family practice practitioner, general internist, or obstetrician or gynecologist.“(7) Publication of list of counties; posting on website.—With respect to a year for which a county or area is identified or revised under paragraph (4), the Secretary shall identify such counties or areas as part of the proposed and final rule to implement the physician fee schedule under section 1848 for the applicable year. The Secretary shall post the list of counties identified or revised under paragraph (4) on 117 STAT. 2277 the Internet website of the Centers for Medicare & Medicaid Services.”.(b) Improvement to Medicare Incentive Payment Program.—(1) In general.—Section 1833(m) (42 U.S.C. 1395l(m)) is amended—(A) by inserting “(1)” after “(m)”; (B) in paragraph (1), as designated by subparagraph (A)—(i) by inserting “in a year” after “In the case of physicians’ services furnished”; and(ii) by inserting “as identified by the Secretary prior to the beginning of such year” after “as a health professional shortage area”; and(C) by adding at the end the following new paragraphs:“(2) For each health professional shortage area identified in paragraph (1) that consists of an entire county, the Secretary shall provide for the additional payment under paragraph (1) without any requirement on the physician to identify the health professional shortage area involved. The Secretary may implement the previous sentence using the method specified in subsection (u)(4)(C).“(3) The Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services a list of the health professional shortage areas identified in paragraph (1) that consist of a partial county to facilitate the additional payment under paragraph (1) in such areas.“(4) There shall be no administrative or judicial review under section 1869, section 1878, or otherwise, respecting—“(A) the identification of a county or area; “(B) the assignment of a specialty of any physician under this paragraph; “(C) the assignment of a physician to a county under this subsection; or“(D) the assignment of a postal ZIP Code to a county or other area under this subsection.”.(2) Effective date.—The amendments made by paragraph (1) shall apply to physicians’ services furnished on or after January 1, 2005.(c) GAO Study of Geographic Differences in Payments for Physicians’ Services.—(1) Study.—The Comptroller General of the United States shall conduct a study of differences in payment amounts under the physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w–4) for physicians’ services in different geographic areas. Such study shall include—(A) an assessment of the validity of the geographic adjustment factors used for each component of the fee schedule;(B) an evaluation of the measures used for such adjustment, including the frequency of revisions; (C) an evaluation of the methods used to determine professional liability insurance costs used in computing the malpractice component, including a review of increases in professional liability insurance premiums and variation in such increases by State and physician specialty and methods used to update the geographic cost of practice 117 STAT. 2278 index and relative weights for the malpractice component; and(D) an evaluation of the effect of the adjustment to the physician work geographic index under section 1848(e)(1)(E) of the Social Security Act, as added by section 412, on physician location and retention in areas affected by such adjustment, taking into account—(i) differences in recruitment costs and retention rates for physicians, including specialists, between large urban areas and other areas; and(ii) the mobility of physicians, including specialists, over the last decade. (2) Report.—Not later than 1 year after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1). The report shall include recommendations regarding the use of more current data in computing geographic cost of practice indices as well as the use of data directly representative of physicians’ costs (rather than proxy measures of such costs).