Top-down method out of favor with some MDs
Why one PCP group doesn't like it
Primary care physicians get upset when talking about HCFA's proposed top-down method of revamping practice expense payments because they feel it is more like the approach they want to move away from - which favors surgeons - than the long-awaited rewrite they have been promised by both Congress and federal regulators.
Under the proposed top-down methodology, each specialty's current pool of practice expense dollars is influenced by how much Medicare paid for its practice expenses under the existing charge-based system, as well as how private-pay patients and other insurers reimburse physicians, according to the American College of Physicians-Society of Internal Medicine (ACP-ASIM) in Washington, DC.
In turn, specialties whose services have historically been overvalued, such as cardiologists and thoracic surgeons, will benefit from this approach because it allocates payments to specific services from the historical pool for each specialty. In contrast, primary care groups argue that a bottom-up approach - which uses expert panels to estimate and project expenses - is not directly influenced by each specialty's historical share of practice expenses because estimates are used rather than actual historical costs.
Under the 1997 proposed rule, for instance, an internist would only need to conduct 15 midlevel established patient office visits to obtain the practice expense reimbursement of a single coronary triple-bypass graft, compared to 92 midlevel visits under the previous charge-based formula.
But, under HCFA's latest June approach, the same internist has to provide 40 office visits to obtain the practice expense reimbursement for a coronary bypass. "This is an improvement over the existing payment disparity," notes ACP-ASIM spokeswoman Barbara Lauter, "but far less of an improvement than would have occurred under last year's proposal."
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