WASHINGTON-FPs and internists are headed again for the good side of Medicare's ledger.
After this year's 2.3% rollback of primary-care payments, the Physician Payment Review Commission says a 2.7% rise is due in 1997 unless Congress chooses to intervene.
Nonsurgical services would be the 1997 loser, with a 0.6% payment cut. PPRC says surgical payments would increase by 2.1%.
This year's primary-care loss was enacted automatically because volume exceeded HCFA's 1996 growth target, the volume performance standard. Congress declined to change the update.
Primary care's resurgence came from a rise in volume of services that was 0.5% under the 13.8% target set last year. Nonsurgical services' volume topped a 4.4% growth cap by 2.8%.
PPRC says the three-part update continues to subvert RB-RVS' redistributive goal, and it once again advised Congress that a single conversion and update is needed. The gap between the three conversion factors could grow to $7.24 (see chart). Congress is showing signs of listening, but action is doubtful. PPRC has suggested sweetening the switch to a single factor by phasing it in over three years. AMA backs that. Primary-care groups don't.
PPRC says that under a three-year phase-in, primary care's conversion factor would rise an average of 0.8% per year. Surgery would fall 3.8% in each year of the transition; nonsurgical services would gain 1.5%. The 1999 conversion factor would be an even $36.26.
The three-year transition is needed because of the large reductions expected when practice expenses are rebased from historical cost to a resource-based scale-a move that is expected in 1998. Surgeons will see the biggest cuts from the practice-expense shift.-Joe R. Neel
WASHINGTON-FPs and internists are headed again for the good side of Medicare's ledger.
