The government is proposing to tighten Medicare reimbursement policy for teaching physicians by forcing them to be physically present when residents perform major treatment on beneficiaries.
The rule, which is being proposed by HCFA, would change a longstanding policy that permits Medicare Part B payments to attending physicians who provide only general direction to interns and residents who are involved in direct care of patients. Physicians don't have to be present when the interns or residents are treating the patients.
Under the proposal, the doctors would have to be present when key portions of a service are delivered.
HCFA's plan is one of several proposed physician fee schedule revisions for 1996.
But provider groups said the proposed rule would disrupt primary-care training programs because those programs emphasize greater independence by residents as they progress.
In addition, the rule would be in conflict with federal policies that are trying to promote such training. If HCFA's plan requires more direct supervision, it would require such training programs to hire more teaching physicians, provider groups said.
"It just flies in the face of the way the health system is evolving," said Randy Teach, Washington office director for the Medical Group Management Association. Greater emphasis on primary care and outpatient care is "the way practice is going, and that's the way education is going to go because we can't afford the infrastructure anymore."
Training programs for more invasive specialties might not be affected as much because training for such procedures requires much more physician oversight.
But HCFA's proposed rule also left the door open to a compromise with the family practice programs and invited their participation in developing a rule that will accommodate the "unique nature" of those programs.
Charles Huntington, Washington office director for the American Academy of Family Physicians, said his group will pursue such a compromise. But he added, "We've been in with them for literally decades asking for accommodation, and we have nothing new we can tell them."