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ACP: Medicare credibility 'at stake'

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

The College has written to HCFA urging the agency to answer mounting criticism of the way it is recalculating practice costs for Medicare's RBRVS-based fee schedule, saying "the credibility of Medicare physician payment is at stake."

The College has strongly supported HCFA's efforts to fix problems with the practice-expense component of Medicare fees by a Congressionally-set deadline of Jan. 1, 1998, but many other physician organizations including the AMA, have urged a year-long implementation delay. Reform of the practice-expense component threatens to reduce overall pay for some surgical services and to substantially increase pay for office evaluation and management visits. Practice costs account for about 45% of the amount doctors are paid by Medicare for providing any given service.

A draft regulation, which would lay out the new practice expenses determined by resource utilization as opposed to historical charges, is expected to be issued in May.

"Maintenance of the historically charge-based system, which has already been in effect for six years and has been highly inequitable, is inconsistent with the original intent of the fee schedule," ACP Immediate Past President Christine K. Cassel, MACP, wrote to HCFA Administrator Bruce C. Vladeck, PhD, last month. "While converting to a resource-based system is long overdue, at the same time, we believe that this rule can go forward only if it is methodologically sound and defensible."

The College is also concerned that preliminary data released by HCFA this winter could have a negative impact on internal medicine subspecialties, particularly cardiology and gastroenterology. ACP officials say they need more information about how these figures were calculated.

ACP, along with the American Society of Internal Medicine, the American Academy of Family Physicians and the American Academy of Pediatrics, has stated that any decisions on delay or change in the Congressional mandate should be made only after the rule is published by HCFA and evaluated by all parties.

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