WASHINGTON-HCFA’s practice-expense woes are mounting.
First, it wailed that it couldn’t get studies of practice expenses done by 1998, a deadline set by Congress for a resource-based method of calculating overhead in Medicare payments. But Congress has resisted demands by AMA and others that HCFA delay implementation pending those studies.
Now HCFA says it’s walking away from a $600,000 mail-in study of practice expenses it commissioned. It was considered a pivotal data-collection study before the shift from a historical-cost basis. HCFA said the Abt Associates study had a response rate of only 25%, less than half of what was needed-despite pleas by specialty societies to members to fill out questionnaires.
Still, HCFA plans to draw up the new payment schedule on schedule. It says other studies under way will be good enough for an initial swipe, with corrections to come. Preliminary data from those studies suggest Medicare reimbursement will tumble for procedure-oriented doctors, no matter which study is used (see chart). Under its budget-neutral mandate, HCFA will pass the savings on to cognitive-based specialties-RB-RVS’ original intent.
The American College of Surgeons says HCFA’s continuing troubles show that it’s unprepared for the fee-schedule tinkering. It wants a year’s delay at a minimum, plus a long phase-in of the new rates. But the American Society of Internal Medicine will brook no delay, maintaining that Congress did not dictate that the survey of physicians be performed before HCFA makes changes.
They’ll be based on a 1989 study showing the average practice spending 41.0% of its gross on wages, equipment, supplies, rent, and utilities, plus 4.8% on malpractice premiums. The practice net was 54.2%. -Joe R. Neel
WASHINGTON-HCFA’s practice-expense woes are mounting.
