Some primary-care and specialty physician groups believe they may be able to equalize Medicare fees between surgeons and other doctors by capitalizing on Congress' current budget-cutting mood.
The American Society of Internal Medicine, the American Academy of Family Physicians and about 20 other nonsurgeon specialty groups are asking Congress to mandate a single "conversion factor" for calculating Medicare fees.
Congressional budget proposals that aim to balance the federal budget by 2002 call for trimming as much as $283 billion from projected Medicare spending between 1996 and 2002.
One of the proposals to achieve those savings would be to reduce the conversion factor for surgical services to that of primary-care services in 1998, which the House Budget Committee said could save $5.8 billion.
Surgeons argue against such a proposal, contending that the difference in the conversion factors reflects their ability to restrain the growth in the volume of Medicare surgical services.
Today, separate conversion factors exist for the three categories of services-primary care, surgery and nonsurgical specialty procedures. The surgery conversion factor for 1995-$39.45-is 8.4% greater than the $36.38 primary-care conversion factor and 14% greater than the $34.62 factor for other nonsurgical services.
The surgical conversion factor was only 2.3% greater than the other categories in 1993, the first year of separate conversion factors. If a built-in default formula takes effect for 1996, the difference could grow to more than 15%.
To calculate fees for a specific physician service, HCFA assigns a number of work units to that service. The number of work units is then multiplied by the conversion factor to establish the service's fee.
The conversion factors are adjusted annually. Each conversion factor is increased if doctors in that category kept their growth in the volume of Medicare services below a government-set standard or reduced if the standard was exceeded.
The Congressional Budget Office projects that Medicare will pay doctors $32.8 billion in fiscal 1995, which ends Sept. 30.