The Prospective Payment Review Commission is recommending that Congress further close the gap between Medicare payments for surgeons and primary-care physicians.
The panel, which advises lawmakers on physician-payment issues, last week recommended that surgeons receive a 10.7% increase in Medicare fees in 1995 instead of more than 13%. Still, that would be the largest increase since the resource-based relative value scale was implemented in 1992. Primary-care physicians would receive a 10.1% boost, while reimbursement for all other services would increase 7.4%.
In determining its adjustments, the PPRC decided not to use the formula instituted by Congress in the original legislation. That formula would have resulted in a surgical update of 13.2%, while primary-care physicians would have received a 9.4% boost, according to commission calculations. Reimbursements for all other services would have been raised 6.7%.
Overall, the PPRC recommended an 8.6% increase in physician payments, which, according to the commission, would raise the Medicare payment rates to 62% of those paid by private insurers. Medicare now pays 59% of what private insurance pays.
Last year, surgeons received a 10% increase while primary-care physicians' reimbursements rose 7.9%. All other services rose 5.3%.
Congress has the option of accepting the PPRC recommendations, choosing the recommendation of HHS or choosing a separate set of updates. If Congress doesn't act, the formula set in law would take effect on Jan. 1.
HHS was scheduled to make its recommendation to Congress on April 15 but has yet to do so.
The decision to close the gap between surgeons and primary-care physicians did not come as a surprise to surgeons.
"This is the usual pattern," said Cindy Brown, manager of the Washington office of the American College of Surgeons. "We think (Congress) ought to preserve the differential, but we can live with a 10.7% increase."