Primary-care doctors will get a residual boost to their Medicare practice compensation over the next three years under HCFA's final rule establishing the physician fee schedule for 1999.
The move may induce a lawsuit against the agency by groups representing surgeons and specialists who will lose money under the rule, which was released Friday.
The dispute stems from provisions of the Balanced Budget Act of 1997 instructing HCFA to impose a "resource-based" formula on practice-expense payment. Such payments for rent, equipment and office labor represent about 40 cents of every dollar Medicare pays physicians.
At stake is roughly $4 billion that may be shifted to primary-care doctors from 1999 to 2002.
Resource-based payment for practice expenses, similar to the payment formula used to compensate physicians' professional work, was required under 1994 legislation to take effect in 1998. It replaces a formula that relied on historical charges to establish practice-expense compensation.
Last year's balanced-budget law delayed that implementation date by a year and provided for a three-year transition. But it also provided a "down payment" of up to $390 million in 1998 to primary-care office visits from surgery and specialty procedures.
The HCFA rule, to be published this week in the Federal Register, calls for the 1998 practice-expense payments as the baseline for the transition to the new schedule.
However, specialty and surgical groups said using that baseline will mean a continued shift of payments from them to primary-care physicians. The American College of Cardiology, for example, estimated that the 1998 baseline will cost them 0.8% of net Medicare revenues in 1999.
The specialty groups argued that the balanced-budget law did not call for that continued shift, and they have threatened to sue HCFA if the rule takes effect.
HCFA argues, however, that to use 1997 as the base year would yield a reduction in practice-expense compensation for primary-care office visits in 1999. Furthermore, the agency said, a 1997 baseline would symbolize a return to an "outmoded" practice-expense compensation system.