Physician groups are warning that the Medicare fee schedule may be used as a tool to drastically limit payments to doctors and could result in reduced access for beneficiaries.
Testifying at the annual public hearing of the Physician Payment Review Commission, physicians cautioned that both the Clinton administration and the Republican-led Congress will be looking to squeeze the Medicare program to reduce the federal deficit or finance healthcare reform. PPRC advises Congress on physician payment issues.
James Todd, M.D., executive vice president of the American Medical Association, said the mechanism HCFA has used since 1992 to determine Medicare's fees for specific services could be manipulated to reduce the growth of Medicare spending. The fee schedule was designed to compensate physicians based on the time, effort and knowledge needed to provide services. It also was intended to give physicians predictable annual fee increases.
"The very structure of physician payment reform could be twisted for budget reduction," Dr. Todd told commission members. "The only consequence can be reduced access for Medicare beneficiaries."
"We're seeing signs of stress in the Medicare program," said Martin Corry, federal affairs director with the American Association of Retired Persons.
In written testimony, Alan Nelson, M.D., executive vice president of the American Society of Internal Medicine, said a possible change aimed at discouraging physicians from providing unnecessary or marginal services could cause a relative decrease in Medicare fees when compared with private-sector rates. Medicare actuaries say the proposal would save $5 billion between fiscal years 1996 and 2000.