Attorney plans lawsuit to force Medicare to pay doctors more: San Diego shortchanged $30m this year, $160m since 2001.

A class action lawsuit involving San Diego doctors and Medicare reimbursements is expected to be filed in federal court this week.

Attorney Dario de Ghetaldi said May 30 that he planned to file June 4 in the Northern District of California on behalf of seven counties in the state. The complaint would be filed against the U.S. Department of Health and Human Services.

De Ghetaldi, a-Bay Area attorney, is representing San Diego, Santa Cruz, Sonoma, Marin, Santa Barbara, San Luis Obispo and Monterey counties in the lawsuit.

The counties are seeking to force Medicare administrators to end the way they currently decide how much doctors in different regions get paid for treating patients covered under the 65 and older program.

They are also seeking to force Medicare to compensate doctors who have been "systematically underpaid" for years, said de Ghetaldi, who is with Corey, Luzaich, Pliska, de Ghetaldi & Nastari LLP in Millbrae.

However, he added he was not prepared last week to say how much compensation would be asked for because he was still preparing the court papers.

"We're trying to get Medicare to do the right thing," de Ghetaldi said. "The significant thing about this issue is that there's history showing that Medicare is aware of the problem and has been aware for a number of years but has not done anything."

Dr. Ted Mazer, president of the San Diego County Medical Society, said that in San Diego County alone, doctors who accept Medicare will be shortchanged in excess of $30 million this year.

Since 2001, he said they have been underpaid by more than $160 million.

"If Medicare is under-reimbursing and they acknowledge that they are, then everyone is under-reimbursing," Mazer said, noting that other insurers, such as HMOs, generally follow Medicare's lead when it comes to deciding how much to pay doctors for their services.

The amount a doctor receives for seeing a patient on Medicare is determined by the Geographic Practice Cost Index, or GPCI. The index considers how much it costs to do business in a particular region, including rent and staffing costs.

Apples And Oranges

San Diego County is indexed along with 47 other urban and rural areas. When lower cost factors in rural areas are balanced with" greater local costs, the final payout for all doctors in the index is 5.5 percent less than the actual cost of doing business in San Diego County.

The index has also not been updated since 1996.

Medicare does not reimburse hospitals the same way it does doctors. While there are 89 doctor indexes for the entire country, there are 433 for hospitals. Hospital indexes are updated annually.

De Ghetaldi said the hospital system actually works quite well because it is more specific and he would like to see Medicare duplicate something similar for doctors.

Since 2001, de Ghetaldi said doctors nationwide have been underpaid by $2.5 billion and it's forcing doctors to rethink the way they do business and in some cases, move to an entirely different region where they can work in an area with a better paying index.

"We're seeing doctors refusing to take new Medicare patients and doctors who refuse to take any Medicare patients at all so there's a real crisis because, for the patients in these affected areas, access to care is becoming more and more limited," de Ghetaldi said.

A National Complaint

San Diego County is one of 175 counties in 32 states being paid between 5 percent and 14 percent less than their individual county cost factors warrant.

The 10 most underpaid counties in California are Santa Cruz at -10.2 percent, Sonoma at -8.2 percent, Monterey at -6.7 percent, Marin at -6 percent, San Diego at -5.5 percent, Sacramento at -4.6 percent, Santa Barbara at -3.5 percent, El Dorado at -3.3 percent, Placer at -2 percent and San Luis Obispo at -1.2 percent.

Mazer, an ear, nose and throat doctor, has personally been working on getting doctors in more expensive urban areas more money since 2002.

"Part of the reason we haven't been able to fix it is because it's not important enough to the people in Congress, at least it hasn't been so far," Mazer said, noting that he believes politicians are afraid to change the system because in order to give money back to those underpaid, funds would have to be taken from those overpaid in rural areas that already have limited medical resources.

But that could be changing.

On May 24, Rep. Sam Farr, D-Carmel, introduced H.R. 2484, legislation that would direct the Center for Medicare and Medicaid Services to change the way it groups large urban and rural areas together. It also comes with added funding to make it happen.

The bill could be voted on by the Congress as early as later this year, according to Farr's office.

Reps. Susan Davis, D-San Diego; Brian Bilbray, R-Solana Beach; and Darrell Issa, R-Vista, are co-sponsors.