On the physician budgetary front, the American Medical Association has decided to side with specialists over primary-care doctors in the key battle over how Medicare reimburses physicians for their practice expenses.
AMA lobbyists told House and Senate negotiators last week the association favors delaying for a year a HCFA plan to shift Medicare practice expense dollars to primary-care doctors from specialists. The delay is included in a balanced-budget bill provision adopted by three congressional committees. It would phase in the funding shift over a four-year period (June 30, p. 22).
HCFA's plan would take effect on Jan. 1, 1998. The proposal changes the way Medicare pays doctors for their practice expenses (June 16, p. 4). It could shift as much as $4 billion annually in Medicare payments to primary-care doctors at the expense of specialists.
Specialists, not surprisingly, want the plan delayed, arguing that HCFA's research in developing its new plan was flawed.
Primary-care doctors, however, favor a provision previously adopted by one of the congressional committees, the Senate Finance Committee. That provision would require Medicare to shift $400 million to primary-care physicians in 1998 and phase in the balance by 2001.
Negotiators from the House, Senate and White House are scheduled to begin meeting this week to resolve differences among the various pieces of budget legislation.
Special-interest groups representing primary-care physicians said the AMA had a chance to endorse language that would address the concerns of both its primary-care members and specialists.
"Unfortunately, they chose not to take it," said Robert Doherty, vice president of governmental affairs and public policy at the American Society of Internal Medicine.