It has been well known for years that Santa Barbara county physicians are underpaid by Medicare due to outdated reimbursement formulas because we are classified as a rural area. The high cost of living and a large senior population makes this an especially challenging situation. While we are categorized as rural in this way, we also don’t get the benefit of being reimbursed for telemedicine, because our population is too high. I think this is an example of where the public wants to see some consistency and common sense from the Centers for Medicare & Medicaid Services and other federal agencies. The most recent case filed challenging Medicare’s formulas for calculating reimbursment in the area will hopefully resolve this at last.