A new Medicare rule on billing for teaching physician services could be a financial hit for teaching hospitals and academic medical centers, some physician groups say.
Teaching surgeons, in particular, are unhappy. The rule, scheduled to take effect July 1, requires that, with few exceptions, a teaching surgeon must be physically present with the patient and resident during the critical portion of a service in order to bill Medicare Part B.
Some academic practices say the rule could reduce efficiency, and the American Group Practice Association has asked HCFA to allow doctors some discretion in implementing it.
For instance, the rule requires teaching surgeons to be immediately available during the opening and closing of a patient. That could mean an end to the practice of surgeons at the Mayo Clinic going from one operating room to another, overseeing only the most critical procedures, said Bruce Kelly, the clinic's director of government relations.
Kelly said while there could be financial costs, the prospect of changing surgical procedures is most worrisome.
"We don't want to have surgeons standing around doing nothing," he said.
This month HCFA met with the Medical Group Management Association, the American College of Surgeons and others to get feedback for an implementation manual for carriers. Also, HCFA Administrator Bruce Vladeck discussed the issue with members of the AGPA at its annual conference in Miami Feb. 9.
The AGPA and the MGMA claim lost efficiency will translate into significant financial costs for academic practices, though they couldn't give an amount.
"While there may be a few things on the margin that need clarification, the message is that if the teaching physician is not elbow-to-elbow with the resident, don't bill the service. Period," said Randy Teach, director of the MGMA's Washington office.
HCFA said the teaching physician presence requirement actually dates back to 1969, but teaching physicians' involvement in patient care has varied widely among and within teaching hospitals and carriers have not applied billing rules uniformly.
HCFA also said the rule is necessary because of the 1992 implementation of a resource-based fee schedule for physician services, which bases Part B payments in part on resources expended by doctors. HCFA argues that teaching physicians who are not physically present do not expend any resources.
The AGPA believes the issue may take on more importance given plans by HHS' inspector general's office to issue a report this year focusing on whether clinical practice plans wrongly billed Medicare for physician services actually provided by residents and interns.