A congressional watchdog agency has backed off its previous assertion that surgeons don't deserve Medicare payments for use of their own nursing staff in hospital operating rooms.
The move by the General Accounting Office opens the door to possible compensation of surgeons for such expenses. That could reduce an anticipated shift of billions of dollars from surgeons and specialists to primary-care doctors, as well as bolster doctors' claims that they deserve money now paid to hospitals.
The GAO studied HCFA's performance in developing a June 1997 proposed regulation on changes in Medicare compensation for physicians' practice expenses. HCFA's proposal disallowed compensation for surgeons who bring in their own nursing staff.
The GAO had supported HCFA in an early draft of its report on the proposed rule. But in its final report released last week, the GAO said it could not back the assertion because it had not reviewed data on how often surgeons must provide their own nurses because of cutbacks at hospitals.
HCFA said it will review such data, which it obtained from the American Hospital Association and specialty physician groups, before publishing a new proposed rule. Its deadline is May 1.
The AHA data indicate it's not common for doctors to bring their own surgical personnel into operating rooms. When it does happen, hospitals usually compensate the physician, the AHA said.
The GAO report examined HCFA's development of a proposed rule on "resource-based" practice expense compensation, or payment for such costs as labor, rent, equipment and supplies.
Representing about 41% of physicians' income, practice-expense compensation now is based on historical charges. A 1994 law required that Medicare this year begin resource-based compensation. In balanced-budget legislation last year, Congress ordered HCFA to delay implementation and rewrite the proposal.
The Congressional Budget Office projects Medicare will pay physicians $31.9 billion in fiscal 1998, which ends Sept. 30.