WATERLOO -- Dr. Tim Horrigan practices family medicine, but among his patients are people who would be better off seeing a specialist. They see Dr. Horrigan because there aren't enough specialists to go around.

Add to this the fact that Medicare is proposing holding Horrigan, and doctors like him, to specialists' standards when determining the amount of reimbursement. Under pay for performance standards, that would be tantamount to penalizing him. "And I'm already doing high-level care for family medicine," Horrigan said.

Horrigan was among a dozen or so health care professionals who took part in a roundtable discussion with Rep. Bruce Braley (D-Iowa) at Allen College on Monday afternoon. Braley came to talk about his bill, the Medicare Equality and Accessibility Act of 2007, that would help equalize Medicare reimbursement rates nationwide, and his efforts to re-authorize a scholarship and loan forgiveness program for doctors who work in areas with designated shortages.

Doctors in Iowa are reimbursed at a lower rate than doctors elsewhere in the country -- sometimes at 65 percent of what their peers get, Braley said. Lower Medicare reimbursement rates make it more difficult for Iowa to attract or recruit doctors.

Medicare determines its reimbursement rates by determining the cost of a doctor's labor and the doctor's cost of doing business. Medicare then adjusts that for geographic differences in the cost of services -- known as Geographic Practice Indices (GPCIs). In Iowa, Medicare gives the labor a value of .967, and the cost of doing business a value of .867.

Right now, Medicare sets a minimum value of 1.0 for the doctor's labor, but that expires at the end of this year. There is no minimum value for doctors' cost of doing business.

Braley's bill would make the 1.0 minimum for labor permanent and also establish a permanent 1.0 minimum for expenses.

The scholarship and loan forgiveness program would entice doctors to work in places that have a shortage of health-care professionals. Doctors receiving the scholarships would have to practice medicine in a shortage area one year for every year of the scholarship. Under the loan forgiveness program, doctors can get up to $25,000 a year to put toward the qualified loans for working in a shortage area.

Together, Braley said the measures would make Iowa better able to attract new doctors to the state.

Horrigan said those measures would be a good start -- but just a start.

"The big picture of doing something about the health care system globally has to keep getting worked on and doesn't keep getting put on the back burner," Horrigan said. "The big picture health-care system is at serious risk."

Braley acknowledged the bills would not, by themselves, solve the doctor shortages in some areas.

"There is no magic bullet," Braley said. "What I am trying to do is keep Iowa providers from falling further and further behind …."

Contact Jeff Wilford at (319) 291-1423 or jeff.wilford@wcfcourier.com.