The Clinton administration's latest plan to revamp Medicare's capitation payment system is nearly identical to a previously announced Republican plan. But despite the concord, neither side is hopeful that the payment system can be fixed this year.
Both sides agree that the current formula, which pays managed-care plans a fixed monthly rate that varies from county to county, is seriously flawed.
According to the Physician Payment Review Commission's annual report released April 1, capitated rates now range from a low of $177 a month to a high of $679. The average is $325.
In the White House's latest proposal, which was included in details of the fiscal 1997 budget released recently, it is clear that the Clinton administration's framework is essentially the same as the GOP's.
Both plans aim to reduce the variations between counties by blending the county rate with a national average and by raising the payment rate in the lowest-paid counties to at least $300 a month. That will reduce the payment rates in the highest-cost areas while raising rates in low-cost counties.
Both plans would gradually phase in the changes, and both would assure that after the initial changes are made every county would receive at least a 2% annual increase.
One significant difference exists between the two proposals. The White House plan would remove disproportionate share and graduate medical education payments from the managed-care payments and give the money directly to teaching hospitals and managed-care plans that accept medical residents.
But even though the two plans have nearly identical frameworks, both sides said there is little chance the measure can be passed this year.
"This kind of reform will only happen as part of a larger Medicare package, and I don't see that happening until after the election," said a GOP staffer who asked not to be identified.