Primary-care doctors and specialists are on the verge of a feud over how HCFA adjusts Medicare payments that cover physician practice expenses.
Under a 1994 law, Medicare in 1998 must change its method of reimbursing physicians for their overhead expenses, including rent, supplies, equipment and staff salaries. Those items account for more than 40% of physician compensation. HCFA must change the payment system from a historical cost basis to a resource basis, much as it did in 1992 with reimbursement for physician work (See related story, p. 70).
But many physician groups are raising concerns that some of HCFA's research on practice expenses-being conducted by the research firm Abt Associates of Cambridge, Mass.-will yield inaccurate or even useless data because their surveys and work sheets are long and cumbersome.
They fear that because of the complexity of a survey scheduled to be mailed to 5,000 practices in March, HCFA and Abt Associates won't get the 70% response rate they are seeking. A lower response rate might provide inadequate data, physician groups say.
Specialists and surgeons-who, some believe, stand to lose the most when practice expenses become resource-based-argue that if HCFA and Abt are having a hard time gathering accurate information, Congress should delay implementation until 1999.
"A number of us who are in the field thought neither HCFA nor Abt Associates has the time to do this survey right," said Randy Fenninger, who represents the American Urological Association and the American Society for Gastrointestinal Endoscopy.
Primary-care groups believe that it is "speculative" to conclude that the data necessarily will be useless, although they are concerned about how accurate the data will be, as well as the ability of physicians who have not computerized their practices to respond to the survey.
HCFA and Abt are using three data-gathering tools: The mailing, which will assess such costs as rent, utilities and other overhead costs; expert panels of specialists, which will assess how many supplies and how much equipment use and non-physician labor is involved in each service; and price and wage information from such sources as the Bureau of Labor Statistics and the Census Bureau.