After months of simmering, the dispute between physician specialties over Medicare practice-expense reimbursement is about to boil over again.
And the outcome of the fight could jeopardize physicians' credibility on Capitol Hill as Congress takes up Medicare reform in its 1997 session.
The American Academy of Ophthalmology plans to ask the American Medical Association's House of Delegates to change the organization's existing policy on how quickly HCFA should implement a new way of reimbursing physicians for their practice expenses.
In June, the House of Delegates called on Congress to delay until 1999 the effective date of resource-based practice-expense compensation. Primary-care doctors opposed that policy. The ophthalmologists now plan to ask the House of Delegates, which meets in Atlanta in December, to expand that policy to seek a three-year transition to resource-based practice-expense payment after the 1999 effective date and a requirement that the change not lower the fees for any procedure more than 20%.
A 1994 law calls for Medicare practice-expense payments to be changed in 1998, from a historical charge basis to one based on the office resources needed to complete a service or procedure, similar to the method used to reimburse physicians' work.
Reimbursement for practice expenses-rent, equipment, supplies and staff salaries-represents about 40% of physician Medicare revenues.
Although nobody knows for sure how such a change will affect fees, many expect the change to increase fees for primary-care services and decrease them for surgery and specialized procedures because hospitals assume some of the practice costs of specialized services.
Hospital executives fear that if doctors lose income as a result of changes in the reimbursement formula, hospitals' financial relationships with physicians and their ability to recruit and retain physicians will be affected.
Wayne Powell, assistant director of federal reimbursement policy at the American Academy of Ophthalmology, said resource-based practice-expense payment, along with other proposed changes to the physician fee schedule, could cause "massive redistribution, possibly more massive" than when the fee schedule took effect in 1992.
The ophthalmologists' resolution is getting a mixed response from other specialty groups, which supported the one-year delay because HCFA has struggled to collect and analyze the data necessary to implement resource-based practice-expense payment.
Some other specialty groups fear the new resolution could spark a repeat of the hot debate at the June House of Delegates meeting and give primary-care groups an opportunity to roll back the specialists' victory.
Furthermore, they fear that the ophthalmologists' move will make members of Congress skeptical about the lobbying message of any specialty. This year, specialists lobbied simply for a one-year delay in resource-based practice-expense payment. But if they were also to ask for a transition and a limit on fee reductions, primary-care groups could say specialists don't want resource-based payments to ever be implemented.
A staff member of the House Ways and Means Committee, who asked to remain anonymous, questioned the ophthalmologists' credibility, particularly since they reaped financial reward in earlier years from the high number of cataract surgeries among Medicare beneficiaries.