The American Medical Association House of Delegates last week supported a transition of up to three years to a single Medicare physician payment base after surgeons threatened to leave the organization.
The decision angered groups representing primary-care physicians, who contend that Medicare surgical fees are too high at the expense of primary-care fees.
Congressional balanced-budget legislation calls for a single 1996 Medicare payment base, or "conversion factor," of $35.42. That figure represents a 10.2% cut from a separate 1995 conversion factor for surgical fees and a 2.6% cut for primary-care services, but a 2.3% increase for all other services.
To determine Medicare fees, the conversion factor is multiplied by a numerical value assigned to each service.
The AMA has lobbied in support of the single conversion factor. But surgeons, led by the American College of Surgeons, said the AMA's support of the single conversion factor would "divide the house of medicine" because immediate transition will result in big cuts in surgical fees.
"Surgeons in general cannot look favorably on the AMA come Jan. 1," said Richard Reiling, M.D., ACS delegate to the AMA meeting.
The AMA policy now calls for a transition of "as close to three years as possible" to the single conversion factor. That policy binds AMA lobbyists to at least attempt to substitute the transition for the immediate implementation.
Primary-care physicians, however, opposed the AMA's action, arguing that the high reimbursement rate for surgical services undermines the intent of the existing physician payment system, which aimed to encourage less-expensive primary-care services.
Surgeons "have been getting paid way too much to begin with, and now they want a transition," said Charles Huntington, Washington office director for the Physicians
American Academy of Family Physicians.
Because the proposed transition is likely to increase Medicare costs anyway, Congress instead should choose to raise the single conversion factor so that all specialties can benefit, said Robert Doherty, vice president of governmental affairs and public policy for the American Society of Internal Medicine.