WASHINGTON-HCFA is asking Congress to update its Medicare physician-payment update system.
Donna Shalala, the HHS secretary, has asked for a single conversion factor for the RB-RVS fee scheme, replacing the current tripartite factor. If Congress goes along, all physicians would get a 0.8% rise in Medicare payment in 1997.
The recommendation was in the President’s 1997 budget request and was repeated in Shalala’s annual advice to Congress on payment updates. It’s in sync with AMA policy and Physician Payment Review Commission advice.
If things aren’t changed, says Shalala, payments would rise 2.1% for surgical services and 2.7% for primary care. Pay for nonsurgical services would fall 0.6%. Shalala also wants Congress to dump the Medicare Volume Performance Standard, which sets growth targets for the three categories of services. She’d replace it with a single target based on a “sustainable-growth-rate” system. That would be reckoned by annual growth in gross domestic product plus a small allowance for medicine’s traditionally higher growth.
If Congress agrees with this, the growth target for 1997 would allow a 2.6% across-the-board rise in the volume of Medicare services. If Congress declines, she advises allowing the volume of primary-care services to grow 5.1% under the current system. But the volume of surgical services would have to shrink 1.5% and nonsurgical services 0.8% from last year.
Shalala says the three-update system would cost $10.7 billion more through 2002. PPRC says surgery’s consistently higher updates have distorted RB-RVS’ original intent. -Joe R. Neel
WASHINGTON-HCFA is asking Congress to update its Medicare physician-payment update system.
