For the third year in a row, primary-care physicians are calling for a reduction in the gap in Medicare reimbursement increases between surgeons and other physicians.
That difference is projected to be more than five percentage points in 1995 under Medicare's physician fee-setting system, called the "resource-based relative value scale."
Based on data for the first three quarters of 1993, reimbursements for surgeons would rise 12.6% in 1995, compared with a 7.3% rate hike for primary-care physicians. All other physicians would realize a 4.6% increase.
Increases are based on a formula intended to reward physicians who specialize in primary care, but the rates are adjusted to reflect changes in the volume of procedures based on established targets. Total Medicare physician spending for fiscal 1993 was $31.4 billion.
"Congress is going to have to come up with a permanent fix for this problem or they are going to have to deal every year with angry primary-care physicians who feel they are being betrayed," said Robert Doherty, vice president of governmental affairs and public policy for the American Society of Internal Medicine.
HHS Secretary Donna Shalala may alter the updates at her discretion and was scheduled to make her recommendation on the 1995 update to Congress on April 15. However, as of press time last week, she had not done so.
Primary-care groups sent a letter last week to Ms. Shalala asking that she "recommend a...1995 Medicare fee schedule update for primary-care services that is equal to, or greater than, the surgical update."
"This is not supposed to be the way it works. This was supposed to narrow the gap in physician incomes," said Charles Huntington, director of the Washington Office of the American Academy of Family Physicians.
While the payment disparity between surgeons and primary-care physicians is larger than in the past, it was reduced by Congress, which last year cut the 1995 increases by 2.7 percentage points for all non-primary-care physicians.
For 1994, surgeons received a 10% increase in Medicare reimbursements, while primary-care physicians' rates rose 7.9%. All other physicians received a 5.3% increase.
The yearly update is based on the rate of medical inflation (2.2% for the 1995 update), which is modified by a volume factor. For 1993, surgeons' volume was projected to increase 8.4%. However, according to the data through the third quarter of 1993, surgeons' volume actually had decreased by 4.7%, resulting in the higher surgical update. Non-surgeons' volume rose by 5.7%.