Surgeons and specialists want Congress to delay scheduled changes to Medicare's physician reimbursement policy because they fear the conversion won't be done right.
Surgeons and procedure-oriented specialists are lobbying Congress to delay changing the payment system for practice expenses from a historical-charge basis to a resource basis. The changes, slated to begin in 1998, implement a 1994 law. Doctors already are paid on a resource basis for direct patient care.
HCFA has been collecting and analyzing data on non-patient-care costs through expert panels and a survey that will be mailed to about 5,000 physician practices. So far about 1,500 of the surveys have been mailed. HCFA is awaiting responses from the first wave before it sends any more.
But because HCFA will be required to publish changes to the fee schedule before its data collection and analysis will be complete, specialty societies argue that the agency will be forced to use "proxy" measures that could be inaccurate.
"Let's take another year and do it right," said Randy Fenninger, Washington representative for the American Urological Association. "Why not use the best data to make the decisions?"
Chances are slim that the specialists' campaign will succeed because the medical community is divided and HCFA does not support the delay. In addition, very few legislative vehicles to which a delay could be attached are likely to pass before Congress adjourns later this year.
The Physician Payment Review Commission, a congressional advisory panel, supports a three-year transition to resource-based practice-expense reimbursement.
Medicare accounted for one-fifth of all payments to physicians in 1993, according to HCFA. Payments to physicians are projected to reach $35.1 billion in fiscal 1996, which ends Sept. 30, according to the Congressional Budget Office.
The campaign by surgeons and specialists has triggered a response from primary-care physicians, who say the Jan. 1, 1998, implementation is necessary to correct flaws that discourage less expensive primary-care services.
Primary-care physicians believe such a change to resource-based practice-expense reimbursement will cause a redistribution of income to them from surgeons and other specialists. The primary-care doctors say redistribution will occur because hospitals assume many of the practice costs of surgeons and specialists.
"It's been a long time that practice expense values were based on the old, flawed system," said Rich Trachtman, federal affairs director for the American Society of Internal Medicine. "We think it would be premature to fiddle around with the due date."
The battle is likely to spill over into the American Medical Association's House of Delegates meeting next month, with each side sponsoring a resolution supporting its position.