Primary care doctors offer truce to surgeons
April 1, 2000 3 minutes read
Primary care doctors offer truce to surgeons
A coalition of medical specialty societies has sued to block a Medicare decision to exclude from practice-expense-related reimbursements the time spent by a physician’s clinical staff assisting the doctor on visits to treat hospitalized patients.
The four specialties — anesthesiology, ophthalmology, cataract and refractive surgery, and neurological surgery — estimate they will lose some $300 million in annual Medicare practice expense payments "contrary to Congress’ instructions," the plaintiffs say in the complaint. They are asking the U.S. District Court in Illinois’ Eastern Division to stop Medicare from enforcing this newly instituted provision of the physician fee schedule. "The refusal to recognize all [such] staff . . . and expenses is arbitrary and capricious, an abuse of discretion, and otherwise contrary to law," the complaint states.
The contested change is part of an overall policy revision sought by the Health Care Finan cing Administration (HCFA) in Baltimore, with the support of primary care and office-based physicians. The goal is to lower practice expense calculations for hospital-intensive practitioners on the theory that HCFA already has paid hospitals for most of their expenses. Reimbursing the individual physicians would amount of paying for the same service twice. Meanwhile, HCFA has raised site-of-service payments to those physicians who see most of their patients in their offices.
The specialists recently received a big boost when the primary-care-oriented American College of Physicians-American Society of Internal Medi cine (ACP-ASIM) publicly endorsed the efforts of gastroenterologists and cardiologists to eliminate HCFA’s site-of-service differential for procedures provided less than 10% of the time in the office.
That is big news because ACP-ASIM was the field general for primary care doctors in the eight-year interphysician battle to create a new site-of-service practice expense fee schedule reducing payments to hospital-based practitioners.
In what amounts to a practice expense peace offering to specialists, the ACP-ASIM board has agreed to:
• support "[that] any proposal to resolve the site-of-service problem be consistent with the principle of basing Medicare payments on the relative costs of providing services, rather than on historical charges, and that it be narrowly targeted at endoscopies and other procedures that are done infrequently in the office," according to an ACP-ASIM statement;
• intensify its efforts to get HCFA to include the costs of physicians’ nonphysician clinical office staff in practice expense payments for services provided in a hospital or other health care facility;
• urge HCFA to base practice expense payments on average costs rather than the costs of treating a typical patient;
• support the intent of proposed legislation to increase Medicare payments for endoscopies under Medicare’s colorectal screening benefit;
• urge HCFA to republish the practice expense relative value units (PE-RVUs) scheduled to be fully implemented in 2002 as interim PE-RVUs for another three-year period. The effect would be to keep the PE-RVUs values on an interim basis subject to public comment and change for up to three more years before being finalized;
• establish a practice expense joint work group with other specialties and subspecialty organizations to coordinate future positions on HCFA relative value practice expense proposals.
ACP-ASIM also agreed to stay out of any appeals involving another lawsuit challenging the so-called 1998 practice expanses "downpayment," which critics say illegally raises the baseline for future practice expense payments to primary care docs while excessively lowering them to facility-intensive physicians.
There is one caveat: ACP-ASIM’s promise to stay out of any legal appeals surrounding the downpayment only holds if the court’s "decision does not result in a requirement that internists refund office visit payments to Medicare."
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