Spurred by forecasts of severe financial losses, surgeons and medical specialists are preparing a new push to suspend a new Medicare compensation schedule for practice expenses.
Last month, HCFA released estimates that the change to so-called resource-based practice-expense reimbursement would cause Medicare revenue losses for some surgical and specialty groups of up to 44% (Jan. 27, p. 16). That change in fee schedules is mandated under a 1994 law and will take effect Jan. 1, 1998.
Now, those surgical and specialty groups say they will ask Congress and HCFA to put on hold the scheduled implementation of that reimbursement schedule because they believe HCFA is using flawed data in its analysis of how compensation should be shifted among the various specialties.
Furthermore, they say such deep reductions in Medicare revenues in such a short time could force specialists out of business and disrupt medical care in some communities.
In a letter to HHS Secretary Donna Shalala, Paul Ebert, M.D., director of the American College of Surgeons, said the combination of the practice-expense reimbursement change and other adjustments to fee schedule payments could result in surgeons receiving less than the Medicaid rate for some procedures.
The American Medical Association, meanwhile, reiterated its position that implementation of the new practice-expense compensation system needs to be delayed until 1999.
Primary-care physicians and office-based specialties, which would see increases of up to 54% in Medicare revenues under the new payment schedule, were resolute in their support for the change.
"There's an inequity that has to be corrected," said Robert Doherty, vice president for government affairs and public policy at the American Society of Internal Medicine.
Randy Fenninger, co-chairman of a coalition of specialty groups opposed to the change, said the task for specialty groups is to make Congress and HCFA comfortable about discussing suspending implementation of the new reimbursement formula.
"The problem is getting a Democratic administration to go to a Republican Congress and say, `We goofed,"' Fenninger said.