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.