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IOM Begins Webinar Series on Geographic Variations Report

October 12, 2012—The Institute of Medicine (IOM) Committee on Geographic Adjustment Factors in Medicare Payment Oct. 10 held the first webinar in a series that will discuss its findings and recommendations, as outlined in recent report entitled, “Geographic Adjustment in Medicare Payment Phase II: Implications for Access, Quality, and Efficiency” [see Washington Highlights, July 20].  The first webinar, “The Impact of Medicare Payment Policy on Workforce Supply, Distribution, and Access to Care,” focused on findings and recommendations related to the impact of geographic adjustment on health care workforce distribution and access to care.

Committee member Thomas C. Ricketts, Ph.D., University of North Carolina Chapel Hill, spoke about access to primary care services and suggested that Medicare develop and apply policies that promote access to primary care services in geographic areas where beneficiaries experience persistent access issues. He also pointed out, “there has never been a coordinated national workforce policy, or entity, to direct or contribute to that policy-making process.”

Dr. Ricketts said the committee’s recommendation is “Congress should fund an independent ongoing entity, such as the National Health Care Workforce Commission, to support data collection, research, evaluations, strategy development, and make actionable recommendations about workforce distribution, supply, and scope of practice.”

With regard to how payment affects the distribution of providers, Dr. Ricketts described the committee’s concerns are that “the state of the science on the effect of payment adjustments on location of practice and specialty choice is not ‘optimal,’ most studies are decades old, and do not include geographic adjusters, new payment systems haven’t included practitioner mix, and Medicare rate updates have not considered regional costs or cost differences.”

Another committee member, Joanne Pohl, Ph.D., ANP-BC, FAAN, FAANP, University of Michigan School of Nursing, also discussed access to care, but spoke more about non-physician health care providers. She said, “In order to promote access to appropriate and efficient primary care services, Medicare should support policies that allow all qualified practitioners to practice to the full extent of their educational preparation.” The committee’s recommendations are there is a “need for standardized, consistent workforce data.”

Also speaking about scope of services and practice reforms, Barbara Safriet, J.D., L.L.M., Lewis and Clark Law School, Portland, Ore., who contributed to the report, said, “Successful implementations of the committee’s recommendations to promote beneficiaries’ access to appropriate and efficient primary care services will depend in significant part [on] rationalizing the current policies and laws.”

The IOM committee will hold its second webinar, “The Impact of Recommended Changes to Improve Accuracy of Geographic Adjustment in Medicare Payment:  Key Findings and Policy Implications from IOM Payment Simulations,” on Oct. 17.


Len Marquez
Director, Government Relations
Telephone: 202-862-6281

Mary Patton Wheatley, M.S.
Director, Health Care Affairs
Telephone: 202-862-6297



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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806