American College of Physicians: Internal Medicine — Doctors for Adults ®

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Primary care physicians defeat delay in pay reforms

From the January 1997 ACP Observer, copyright 1997 by the American College of Physicians.

Primary care physicians banded together during the AMA House of Delegates' interim meeting last month to stave off an initiative that sought to delay Medicare payment reform.

A resolution, authored by the American Academy of Ophthalmology and supported by many surgical specialties, asked the AMA to seek congressional action to slow implementation of new resource-based relative values for the practice expense component of Medicare pay. The new system for determining practice expenses—which Congress has directed to begin by Jan. 1, 1998—is expected to reduce overall pay for some surgical services and substantially increase pay for office evaluation and management visits.

In addition to asking that practice expense changes be delayed by one year, the resolution called for Congress to cap the amount by which any particular service could be reduced and also to phase in the new values over a three-year period.

ACP, working with the American Society of Internal Medicine and internist members of many AMA state delegations, convinced the House of Delegates to reject a compromise that would have substantially achieved the ophthalmologists' objectives. Primary care physicians argued that the recommendation would result in continued inequity in Medicare pay.

James Borland Jr., FACP, the College's alternate delegate to the AMA, argued against further delay, noting that some primary care physicians are being forced out of practice because they are unable to cover their overhead costs.

"This is a matter of equity and justice," said AC Executive Vice President Walter J. McDonald, FACP . "A substantial portion of what Medicare pays for taking care of patients is still historically based, and that history is way out of date."

Although the AMA rejected the new proposal, it did reaffirm an existing AMA recommendation that Congress delay the implementation by one year, but with no transition period or limit on how much services could be reduced.

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