Because of low response rates, HCFA has canceled a mail survey of 5,000 physician practices that was to be used to develop a new Medicare compensation schedule for practice expenses.
Practice-expense compensation represents about 40% of physician Medicare revenues, and the change is expected to shift reimbursement among specialties.
Although it is not certain how the new compensation system would shift payments, primary-care physicians believe they will see their Medicare reimbursement increase. They say the bulk of the practice costs of surgeons and procedure-oriented specialists is assumed by hospitals.
The mail survey was to assess such overhead costs as rent and utilities. It was to be used in developing a new method for Medicare reimbursement of practice expenses that would be resource-based, as physician work now is, instead of based on historical charges. Under a 1994 law, practice-expense payment will change to the resource-based method beginning in 1998.
HCFA officials had hoped for a 70% response rate, but it was not known how many physicians actually answered the survey.
Specialists said the cancellation of the survey strengthens their argument that Congress should delay implementation of the new practice-expense payment schedule until 1999. They said HCFA won't have enough information to publish regulations next year implementing the new schedule.
"(HCFA) won't have the data, and they shouldn't go forward," said Marie Michnich, senior associate executive vice president with the American College of Cardiology.
Primary-care doctors, however, said the 1994 law never required HCFA to conduct a mail survey to determine how to reimburse physicians for indirect overhead costs.
They said that since HCFA already has contracted with such researchers as Harvard University to evaluate those costs based on existing data, the physician survey is not a necessary component of its data collection. Therefore, they said, there is no need to delay implementation of the new payment schedule.
"It isn't a question of having a few more months. (The survey) isn't going to fly," said Robert Doherty, vice president for governmental affairs and public policy with the American Society of Internal Medicine. "The survey instrument was fundamentally flawed."
Some specialty groups have been told by their lawyers that they may have grounds to sue HCFA under Medicare law and the federal Administrative Procedures Act if the agency implements practice-expense reimbursement without first compiling survey data.