2009 RBRVS GPCI Analysis

Wow, some shockers.  Anyone here live in Alaska?

Just like last year, I’ve gone through the entire GPCI catalog and have calculated the impact of the geographical adjustment changes for RBRVS in 2009.  While folks focus 99% of the attention on the impact of individual codes or the new annual multiplier, not enough attention is paid to the GPCI impacts.  For some of you, the impact is greater than any change.

Some highlights from the table below:

  • Whoa, Alaska!  What has happened there that has called for a 22% increase in Medicare rates?
  • OK, New Orleans I understand.  They probably have a problem with doc volume right now and will for a bit.  But why is Ventura, CA enjoying a 3.7% increase over the last two years while Santa Clara, SF, Oakland, etc., are getting killed?  Why is LA “doing well?”
  • I’m sure it’s out there somewhere, but does someone have a good resource for explaining the creation and adjustment of this table?  I still scratch my head at having distinct pricing for places like…Brazoria, TX or Beaumont, TX but there’s nothing distinct for San Antonio.  Or even here in VT, where practicing in Chittenden County is not at all like practicing in the Northeast Kingdom (though some could argue that anyone providing medical service up in the Kingdom should get a bonus).  I have plenty of clients who either benefit or are zapped – usually the latter – by this piece of the calculation.
Location Difference (’08-’09) Difference (’07-’09)
Alaska 22.24% 21.43%
New Orleans, LA 2.13% 4.31%
Ventura, CA 1.84% 3.70%
Rhode Island 1.55% 3.21%
Miami, FL 1.33% 2.75%
Los Angeles, CA 1.31% 2.69%
Fort Lauderdale, FL 1.22% 2.47%
Hawaii/Guam 0.92% 1.72%
Rest of Pennsylvania 0.85% 1.67%
Rest of Louisiana 0.61% 1.23%
Rest of Missouri* 0.61% 1.22%
Rest of Florida 0.58% 1.12%
Anaheim/Santa Ana, CA 0.52% 1.09%
Idaho 0.46% 0.93%
Mississippi 0.47% 0.89%
Indiana 0.48% 0.87%
Beaumont, TX 0.43% 0.81%
Delaware 0.42% 0.79%
Arkansas 0.38% 0.77%
Connecticut 0.34% 0.74%
South Carolina 0.42% 0.74%
Vermont 0.33% 0.61%
New Mexico 0.33% 0.56%
Rest of Texas 0.30% 0.55%
Northern NJ 0.26% 0.49%
Rest of New Jersey 0.23% 0.47%
Rest of Illinois 0.20% 0.40%
Tennessee 0.24% 0.38%
Rest of Maryland 0.17% 0.30%
Nebraska 0.20% 0.29%
Southern Maine 0.11% 0.26%
Oklahoma 0.11% 0.23%
Ohio 0.13% 0.21%
Rest of Georgia 0.13% 0.20%
Virginia 0.14% 0.18%
North Carolina 0.10% 0.16%
Galveston, TX 0.09% 0.13%
Rest of Oregon 0.09% 0.08%
Metropolitan Philadelphia, PA 0.01% 0.07%
Rest of Maine 0.06% 0.02%
West Virginia 0.03% -0.00%
Rest of Massachusetts -0.04% -0.04%
Rest of California* -0.07% -0.15%
Kentucky -0.06% -0.19%
Alabama -0.11% -0.22%
Kansas -0.11% -0.22%
Iowa -0.10% -0.26%
Puerto Rico -0.12% -0.30%
Montana -0.18% -0.36%
Rest of New York -0.15% -0.40%
Queens, NY -0.23% -0.43%
New Hampshire -0.22% -0.44%
Rest of Washington -0.21% -0.52%
South Dakota -0.25% -0.54%
Poughkpsie/N NYC Suburbs, NY -0.31% -0.58%
NYC Suburbs/Long I., NY -0.32% -0.68%
Wisconsin -0.33% -0.72%
Wyoming -0.34% -0.74%
Baltimore/Surr. Cntys, MD -0.41% -0.76%
Utah -0.36% -0.77%
Rest of Michigan -0.37% -0.80%
Nevada -0.44% -0.87%
East St. Louis, IL -0.42% -0.88%
Manhattan, NY -0.44% -0.92%
Metropolitan St. Louis, MO -0.44% -0.92%
Metropolitan Kansas City, MO -0.47% -1.03%
DC + MD/VA Suburbs -0.61% -1.26%
Houston, TX -0.64% -1.27%
North Dakota -0.64% -1.33%
Colorado -0.73% -1.40%
Minnesota -0.70% -1.43%
Fort Worth, TX -0.81% -1.70%
Virgin Islands -0.84% -1.72%
Metropolitan Boston -0.87% -1.76%
Chicago, IL -0.97% -1.92%
Portland, OR -1.01% -2.00%
Brazoria, TX -1.03% -2.13%
Suburban Chicago, IL -1.12% -2.22%
Detroit, MI -1.10% -2.23%
Arizona -1.11% -2.24%
Seattle (King Cnty), WA -1.19% -2.35%
Dallas, TX -1.44% -2.79%
Austin, TX -1.53% -3.01%
Marin/Napa/Solano, CA -1.80% -3.54%
Atlanta, GA -1.93% -3.79%
Oakland/Berkley, CA -1.98% -3.88%
San Francisco, CA -2.20% -4.31%
San Mateo, CA -2.20% -4.35%
Santa Clara, CA -5.04% -9.57%
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