Practice expense 'down payment' stirs controversy
Surgeons at odds with primary care physicians
The debate over pending changes to HCFA's practice expense formula (see related stories, p. 155) includes many battles within the war. One area of skirmishing between physicians is the so-called "down payment" of 10% of the final estimated $390 million in annual Medicare payments that will be transferred from surgeons to primary care groups once the new practice expense rules are fully implemented in 2001.
This down payment, enacted by Congress, increased the 1998 practice expense RVUs for office visits, while lowering them for procedures whose work RVUs exceeded their practice expense RVUs by more than 110%. For instance, as the chart on p. 156 shows, the down payment reduced Medicare payments to cardiac surgeons by 2.9% in 1998, while increasing payments to family practitioners an average of 2%.
Surgical groups, however, are still lobbying to have this down payment limited to 1998 payments and to remove any effect during the four-year transition period until the practice expense RVUs are fully phased in.
"The legislative history of this provision clearly demonstrated that Congress intended for the down payment to be just the first-step reward toward increasing the practice expense RVUs of undervalued office visits," says ACP-ASIM communications specialist Jamie Winson Bass. Once the relative value units are adjusted by the down payment, this would serve as the base for gradually blending in the new payment formula during the calendar year 1999, 2000, and 2001 transition period.
No way, say groups like the Washington, DC-based Practice Expense Coalition, representing hospital-intensive physicians. Instead, the Coalition argues that the down payment was only intended to be a one-time deal, and its impact should be removed from all future baseline calculations because it effectively bends the future RVU curve in favor of even higher payments for primary care physicians.
HCFA spokespeople say HCFA officials believe Congress wanted to include the 1998 down payment in future RVU payment schedules.
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