2014 GPCI Analysis

It what has become a (nearly) annual tradition – check out 2008, 2009, 2011, 2012 –  it’s time to see what the new GPCI adjustments have in store for us this year.  What’s a GPCI (pronounced “Gypsie”), you ask?  It’s the geographical adjustment made to each and every RVU based on where you practice.  You can read my previous blog posts for a primer or check what others have said here, here (great details), or here.

To put this in perspective, the GPCI can swing the Medicare dollars paid for a single RVU by $15 or more…meaning that your 99214 that pays about $92 in Puerto Rico pays $150 in Alaska!  A less extreme, more populated extreme might find a $20 difference between Tulsa, OK and San Francisco, CA.  Multiply that by a few thousand RVUs every year, and it adds up.

I like to check the change in the GPCI values every year because I (and now a few others) have noticed that the Feds have slipped in a subtle payment decrease over the years.  You can see the entire table at the bottom, but let’s look at 2014’s highlights.  First, the winners:

State/County GPCI Change
NYC Suburbs/Long I., NY 1.6%
Rest of Louisiana 1.5%
New Orleans, LA 1.4%
Queens, NY 1.4%
Poughkpsie/N NYC Suburbs, NY 1.2%
Los Angeles, CA 1.1%
Marin/Napa/Solano, CA 1.0%
Manhattan, NY 1.0%
Puerto Rico 0.9%
Alaska 0.8%

The two biggest cities in the country (NYC, LA) get real boosts in 2014 – a change from years past.  The losers, though, are painful.

State/County GPCI Change
Detroit, MI -2.3%
Miami, FL -1.1%
Fort Lauderdale, FL -1.0%
Rest of Washington -0.9%
Rhode Island -0.8%
Ohio -0.8%
Rest of Florida -0.8%
Chicago, IL -0.7%
Suburban Chicago, IL -0.7%
Nevada
-0.7%
Seattle (King Cnty), WA -0.6%

Does Florida need to have a worse healthcare environment (especially for children)?  Does Detroit need to be kicked while it’s down and filing for bankruptcy?  I think not.

How about changes since 2008?  What have the last 5 years done?  Here are the top and bottom 5.

State/County GPCI Change
Metropolitan Boston -7.0%
Detroit, MI -6.1%
San Mateo, CA -4.5%
Manhattan, NY -4.2%
San Francisco, CA -3.9%
South Dakota 6.6%
North Dakota 7.6%
Wyoming 9.1%
Montana 9.6%
Alaska 22.0%

The only pattern I can discern is a distinct red state/blue state dividing line. Perhaps there are a lot of Republicans on the committee that sets these rates.  Any conspiracy theorists out there? [insert smiley face]

Here’s the final tally for 2014.  Enjoy.

State/County GPCI Change
NYC Suburbs/Long I., NY 1.6%
Rest of Louisiana 1.5%
New Orleans, LA 1.4%
Queens, NY 1.4%
Poughkpsie/N NYC Suburbs, NY 1.2%
Los Angeles, CA 1.1%
Marin/Napa/Solano, CA 1.0%
Manhattan, NY 1.0%
Puerto Rico 0.9%
Alaska** 0.8%
Delaware 0.8%
Colorado 0.7%
Oklahoma 0.7%
Rest of New York 0.7%
South Carolina 0.6%
San Francisco, CA 0.6%
Galveston, TX 0.6%
Alabama 0.6%
DC + MD/VA Suburbs 0.5%
New Mexico 0.5%
Brazoria, TX 0.4%
Houston, TX 0.4%
Virginia 0.4%
Rest of Oregon 0.4%
Iowa 0.3%
New Hampshire 0.3%
Portland, OR 0.3%
West Virginia 0.3%
Fort Worth, TX 0.3%
Rest of California 0.3%
Utah 0.3%
Montana *** 0.3%
Anaheim/Santa Ana, CA 0.3%
San Mateo, CA 0.3%
North Carolina 0.3%
Minnesota 0.3%
Arkansas 0.3%
Austin, TX 0.3%
Connecticut 0.2%
Rest of Maine 0.2%
Santa Clara, CA 0.2%
Vermont 0.2%
Beaumont, TX 0.2%
Rest of Texas 0.2%
Nebraska 0.2%
Rest of New Jersey 0.2%
Ventura, CA 0.2%
Kentucky 0.2%
Arizona 0.2%
Rest of Maryland 0.1%
North Dakota *** 0.1%
Oakland/Berkeley, CA 0.1%
Hawaii/Guam 0.1%
Virgin Islands 0.1%
Rest of Pennsylvania 0.0%
Tennessee 0.0%
Metropolitan Boston 0.0%
Rest of Georgia 0.0%
Wyoming *** 0.0%
Indiana 0.0%
Wisconsin 0.0%
Metropolitan Philadelphia, PA -0.1%
Northern NJ -0.1%
South Dakota*** -0.1%
Dallas, TX -0.1%
Baltimore/Surr. Cntys, MD -0.1%
Idaho -0.2%
East St. Louis, IL -0.2%
Rest of Illinois -0.2%
Rest of Massachusetts -0.2%
Rest of Missouri -0.3%
Metropolitan St Louis, MO -0.3%
Atlanta, GA -0.3%
Rest of Michigan -0.3%
Mississippi -0.4%
Southern Maine -0.4%
Metropolitan Kansas City, MO -0.5%
Kansas -0.5%
Seattle (King Cnty), WA -0.6%
Nevada *** -0.7%
Suburban Chicago, IL -0.7%
Chicago, IL -0.7%
Rest of Florida -0.8%
Ohio -0.8%
Rhode Island -0.8%
Rest of Washington -0.9%
Fort Lauderdale, FL -1.0%
Miami, FL -1.1%
Detroit, MI -2.3%

N.B. – the estimates above are based on an approximated change in value for the most common pediatric codes.  The change in value for, say, a 99213 and a 90460 are going to be fairly different relatively.

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Trackbacks & Pingbacks

  1. […] There are some clear exceptions, though.  The big issue that often gets missed is the GPCI – that is, what is your local Medicare adjustment rate.  Some parts of the country, like Boston, have been killed by it.  Others (particularly Alaska) have seen massive improvement.  My 2014 analysis of this issue is here. […]

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