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

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Policy Briefs

From the October 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

Final Medicare+Choice rule: "mixed impact" for internists

In an Aug. 25 letter to HCFA administrator Nancy-Ann Min DeParle, the College noted concerns about HCFA's Medicare+Choice program final rule, which was published in the June 29 issue of the Federal Register.

The College commented on seven areas of concern identified when the interim rule was released in 1998.

  • Bureaucratic burdens-
    The College believes the final rule will have a "mixed impact." While regulatory burdens have actually increased in some areas, such as collection of physician encounter data, they have decreased in others. For example, reporting credible information about legal violations is no longer mandatory.
  • Definition of "providers"-
    The College is disappointed that the final rule characterizes all health care professionals and facilities as "providers." It urged HCFA to distinguish between physicians and other types of providers to avoid confusion.
  • Beneficiary communication-
    The College lauded HCFA's efforts to communicate beneficiaries' choices and rights under the program through a telephone hotline, a Web site, print publications and outreach events.
  • Beneficiary protections.
    The College pinpointed several refinements that it said will better protect beneficiaries. As part of HCFA's expedited appeals process, beneficiaries should automatically receive a favorable decision if plan arbiters take more than 72 hours to render a decision about an appeal. Plans will also be required to inform beneficiaries about providers who leave the plan or are terminated.
  • Quality measures-
    The College feels that HCFA's processes to measure quality assessment and performance improvement are still too burdensome. HCFA's requirement that coordinated care plans conduct two new performance improvement projects each year could prove overwhelming for physicians. ACP-ASIM, however, is pleased that certain types of Medicare+Choice plans--non-network medical savings account plans, private fee-for-service plans and preferred provider organization-type plans--are held to a lesser degree of accountability.
  • Physician input-
    The College would prefer a formal committee structure to ensure that physicians have some input into Medicare+Choice plans' policies and guidelines. However, the College accepts HCFA's decision to give health plans flexibility in establishing mechanisms to obtain physician input.
  • Denial of care.
    When medically necessary care is denied, the rule appears to make health plans, not individual physicians, responsible. The College noted, however, that the rule does not explicitly identify who is responsible for such decisions. It asked HCFA to clarify the language.

The full text of the College's comments is available online at www.acponline.org/hpp/mcfinal800.htm

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