In a frustrating case of deja vu for specialists, primary-care physicians would receive a small increase in their Medicare payments-at the expense of specialists-in fiscal 2000, under the proposed physician fee schedule.
Surgical specialties face the biggest drops, which would be heaped onto last year's steep cuts (See chart).
"The bad news is getting worse," said Wayne Powell, director of regulatory and legal affairs at the American College of Cardiology, whose members face a 3% cut this year on top of a scheduled 9% decline from 1998 to 2002. "We don't know why we came out lower in this. We've got to ask some questions."
The primary driver of the changes is HCFA's desire to stop paying physicians for the cost of bringing their own clinical staff to the hospital to help care for patients. For example, some surgeons bring their office nurses to the hospital to work with them during procedures.
But Medicare already pays hospitals to staff their facilities and should not pay twice for the same service, HCFA said in the proposed fee schedule, which would take effect Oct. 1.
"Clinical staff at hospitals is the big redistributor this time around," said Randy Fenninger, a lobbyist for the Practice Expense Coalition, a loosely bound affiliation of physician specialty groups. "We're going to try hard to get some of that back in, but I suspect we will not."
Primary-care physicians support HCFA's recommendation.
HCFA will brief the American Medical Association on the fee schedule changes Aug. 18. The proposed schedule was published in the July 22 Federal Register, and comments are due Sept. 20.