Federal Medicare discrimination against Utah physicians could result in inadequate medical care for senior citizens - the very folk Congress sought to protect when it created the health care program in 1966.

That's the message sent to Utah's congres-sional delegation from members of the Utah Medical Association - physicians who want to be reimbursed for their services at a rate in line with the national average.Specifically, they want a national fee schedule based on real costs of care. And Sen. Orrin Hatch, R-Utah, believes they should get it.

"I have always advocated national rates of payment under a DRG (iagnostic Related Group) system for inpatient hospital care," Hatch said in response to concerns from association president Dr. Anthony W. Middleton Jr. "And I agree with you that we need to advocate a national rate of payment for physician services or develop a more equitable formula that does not harm physician services in Utah."

The senator said he wants to discuss with association members ways to control costs, while ensuring physicians equitable reimbursement for their services.

"The Medicare program is very important and I want to ensure that seniors in Utah have access to quality and affordable care," he wrote.

Hatch's words should be music to physicians' ears.

Data collected by the Utah Medical Association's Equity Committee indicate that Medicare currently ranks Utah near the bottom in physician payments.

Middleton said part of the problem is that Utah contains just one Medicare charge locality, meaning that the maximum amount Medicare will reimburse for each procedure is the same for both urban and rural physicians, even though their operating costs greatly vary.

Most states are broken down into many localities. California, in fact, has 28, and Medicare's allowable fees vary for each locality.

Middleton said Utah's allowable Medicare fees are especially low for surgical procedures. Payments for office visits and primary care codes fare somewhat better, but are still low in comparison with the rest of the country.

"When prevailing fees for all codes are averaged, Utah ranks 12th from the bottom out of 117 charge localities," he stressed.

Yet, Utah physicians insist there is no rational explanation for the differences in payment from state to state, especially when great discrepancies in payment occur within the same geographic regions - such as the Mountain West.

"Our research indicates that the actual costs of practice, including such items as malpractice insurance, employee expenses, office rent, and supplies, are not substantially lower in Utah," Middleton wrote to Utah lawmakers. "In many cases the costs are higher in Utah than in our surrounding states."

Middleton said these discrepancies have led to several problems for Utah physicians. In fact, with federal laws holding their charges at "unreasonable" levels, some physicians have been unable to remain in practice. Six Utah neurosurgeons have closed shop - "at a time when more are needed." Even LDS Hospital has had difficulties in providing continuous neurosurgical coverage for trauma patients due to the shortage.

According to the physician/president, unrealistic Medicare fees have had their greatest impact on primary care physicians in Utah, who are under great pressure by the local Medicare carrier - Blue Cross and Blue Shield of Utah - to become "participating physicians."