HCFA is offering doctors a remedy for their No. 1 regulatory headache, in the form of new, simplified guidelines for Medicare.
However, it may take a spoonful of sugar to make the medicine go down.
HCFA last week released the draft 2000 guidelines, which explain how to record the type and scope of "evaluation and management" services like office visits. The documentation is used to substantiate the bills submitted by doctors for Medicare payment. HCFA wants to issue the new guidelines to ward off fraud and abuse. The agency has released numerous versions of the evaluation and management guidelines in recent years; none so far has satisfied physicians.
Physicians claim that the most recent guidelines, in effect since 1997, are too burdensome and require so much paperwork that doctors have less time to spend with patients.
At a town-hall-style meeting at their Baltimore headquarters last week, HCFA officials said they want to begin pilot-testing the new guidelines as soon as possible.
But physicians, afraid of being prosecuted for incorrect documentation and billing, indicated that they were wary of participating in pilot tests unless HCFA promised them immunity from audits.
"You're going to have a very small pilot (test) if you don't provide immunity," said one Delaware physician who declined to give his name.
HCFA officials said they were not in a position to grant sweeping immunity.
"We don't feel a lack of protection is a big issue, because these (draft) guidelines are so close to the 1995 guidelines (used before the 1997 guidelines went into effect)," said Paul Rudolf, M.D., a senior adviser to HCFA's Center for Health Plans and Providers. Rudolf said HCFA has learned a lot in the past few years, and "maybe it's good we're going back" to the 1995 guidelines.
That didn't sit well with some physicians who loathed the 1995 guidelines because they were too simple and didn't take into account the complexity of medical practice, particularly a specialty practice.
The American Medical Association, which helped HCFA develop those guidelines, faced harsh criticism from its members and eventually stopped working with HCFA on the issue.
"I feel like a dog chasing its tail," said Troy Tippett II, M.D., a neurosurgeon from Pensacola, Fla., and an AMA member. "We're right back where we started."
At the same time, physicians made it clear that they are interested in working with HCFA to develop a reasonable set of guidelines.
"We are very appreciative of what HCFA is doing," said Jack Emery, a lobbyist in the AMA's Washington office. "All your efforts are worthwhile. The steps (HCFA) has taken so far are encouraging, but the proof will be in the pudding."
The agency is asking physicians to submit written comments for discussion at a September meeting of the Practicing Physician Advisory Commission.
Because the guidelines are not regulations, there is no formal comment period. However, HCFA officials recommend submitting comments by Aug. 11 for consideration by the advisory commission. Any comments received after that date will be reviewed strictly by HCFA.
HCFA hopes to have the final set of guidelines done by summer 2001 and implemented by January 2002.