AHA and AMA officials may be shopping around competing provider-sponsored organization legislation, but they seem to like similar slogans when it comes to Medicare reimbursement.
In releasing its own Medicare reform plan last week, the American Medical Association called on Congress and the White House to "fix Medicare and fix it now." It's reminiscent of the American Hospital Association's calls in 1994 to "fix it or forget it."
But any Medicare reform scenario touted by the AHA surely didn't include a provision that allows Medicare expenditures on physician services to grow at nearly twice the rate of balanced-budget plans debated by Congress last year. The AMA's plan does.
Calling it a "7% solution," AMA officials pledged to seek a Medicare reimbursement formula under which fees increase at only the rate of inflation and overall physician expenditure growth targets will be only 7% a year.
But after eliminating HCFA's medical-practice inflation index of about 2% for calendar 1997, that allows inflation-adjusted expenditure growth of 5%, or about 3.5 percentage points above the growth in the projected inflation-adjusted per-person gross domestic product of 1.5%.
Under congressional balanced-budget legislation last year, inflation-adjusted expenditure growth targets would have been held at only two percentage points above the GDP figure-a measure of productivity-before HCFA began reducing annual fee updates to less than the inflation rate.
President Clinton's proposal was even less generous, offering doctors a growth target of only one percentage point above the GDP figure.
AMA officials raised the specter of reduced access for Medicare beneficiaries because of the current payment formula, under which payment rates and expenditure growth targets are expected to trend downward over the coming 10 years.
"There comes a time, particularly in an era when physicians cannot shift the cost to some other sector, when physicians cannot provide the service," said AMA President Daniel H. Johnson Jr., M.D., a diagnostic radiologist from Metairie, La.
The AMA's plan, dubbed "Transforming Medicare," is a refinement of a plan that the association sent to Congress in June 1995. Like the previous document, the AMA's new plan also calls for doctors to be allowed to set their own Medicare "conversion factors," or the payment bases used to determine Medicare fees for specific services.
Beneficiaries who choose a physician with a conversion factor lower than the HCFA rate would be given a rebate.
The AMA's 1995 Medicare restructuring document called for about $90 billion in savings from hospitals, home health providers and nursing homes, but sought a $14.5 billion increase in physician expenditures.