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November 1996
Volume 60 |
Number 11
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WASHINGTON REPORT
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| HCFA Abandons Survey of Physician
Practices, Will Rely on Proxy Data to Set Indirect Expenses |
Michael Scott, Director
Governmental and Legal Affairs
In mid-September, the Health Care Financing Administration (HCFA)
advised specialty societies that it was terminating its contract
with Abt Associates Inc. to survey approximately 5,000 physician
practices for the purpose of determining resource-based indirect
expenses involved in the delivery of various medical services
and procedures. HCFA's action did not affect the calculation of
resource-based direct expenses, which HCFA proposes to derive
from determinations of several clinical practice expert panels,
the work of which was completed some months ago.
HCFA's decision to abandon the Abt survey of physician groups
was said to have stemmed from a very low average rate of response,
far below the 60-percent to 70-percent rate HCFA believed was
necessary in order to produce reliable data. HCFA's problem was
also exacerbated by the fact that the low response rate related
only to the relatively small percentage of the 5,000 practices
to be sampled -- as of the time the survey was terminated, survey
forms had been mailed to only one-fourth of the groups on the
full random sample list.
HCFA is required by statute to place new resource-based practice
expenses into effect on January 1, 1998, and as a practical matter,
the abandonment of the survey for indirect expenses means that
in order to meet its deadline, HCFA will need to calculate indirect
expenses from already-existing "proxy" data as to the
relationship between expenses and physician work or physician
time. At a meeting with specialty society representatives on October
9, HCFA representatives expressed guarded confidence that they
would be able to complete the necessary study and analysis in
time to meet the 1998 deadline.
Currently, it is not at all clear whether application of proxy
methodology will prove more advantageous to anesthesiology than
development of values based on a survey of physician practices.
As of this writing, ASA's leadership is considering the merit
of completing a survey similar to that aborted by HCFA, in order
to test the validity of whatever proxy data HCFA may develop.
The proposed rule of resource-based practice expenses is due to
be published next spring, with comments due in the early summer.
Congress Adjourns With a Whimper
As both Republican and Democratic congressional leaders claimed
budgetary victory, Congress adjourned on September 30, thereby
allowing House and Senate re-election candidates more than a month
of campaigning back home before Election Day. Little of interest
to anesthesiologists happened in the final days of the 104th Congress:
- Efforts by specialty physician groups to gain support for
a bill extending the effective date for implementation of resource-based
practice expenses to 1999 never generated significant congressional
interest. Primary care physicians virulently opposed this initiative,
leaving most legislators and their staffs with the impression
that this was merely a food fight over Medicare money within
medicine rather than an effort to ensure that accurate data
was collected by HCFA.
- An American Association of Nurse Anesthetists (AANA) proposal
to advance by one year the split between anesthesiologists and
nurse anesthetists of the "personally performed" fee
in "one-on-one" Medicare cases fell by the wayside
as GOP leaders remained steadfast in their refusal to include
Medicare-related items in the omnibus spending bill for FY 1997.
ASA had agreed to this proposal in connection with the GOP Medicare
reform legislation vetoed by President Clinton last year. A
50-50 split of the personally performed fee will take effect
on January 1, 1998, as a result of HCFA regulatory action, whereas
the AANA proposal would have effectively moved the date up to
January 1, 1997.
- All proposals relating to managed care excesses, including
anti-gag rule legislation, failed to gain inclusion in any of
the several appropriations bills adopted at the end of the session.
Thus, except for the requirement in the insurance portability
legislation that HCFA study the extent to which managed care
plans were denying patient access to needed care, the various
proposals of the ASA-supported Patient Access to Specialty Care
Coalition were blocked by the managed care industry.
The 104th Congress has thus ended without having taken any action
on the larger and smaller issues facing Medicare, except perhaps
with respect to broadened anti-fraud efforts. As noted in the
October 1996 "Washington Report," this means that 1997
will almost certainly be a seminal year in terms of Medicare reform,
and of course, the precise shape of that reform will depend on
whether the Republicans retain control of Congress. Whether or
not a change occurs, however, neither party can reasonably expect
to have a clear working majority, which in turn means that centrist
members of the House and Senate, such as the "Blue Dogs"
in the House, will ultimately hold the key.
For anesthesiology, without question, the biggest issue will
be the treatment of the specialty in connection with the move
to a single conversion factor. As reported in October, this can
mean a 13-percent to 14-percent difference in the value of the
Medicare conversion factor. Of almost equal importance will be
the extent to which physicians in general are asked to bear the
burden of the inevitable limitations on Medicare spending. By
the time this column appears, the results of the election will
have become known; no matter which party wins what, however, the
prospects for painful Medicare reimbursement in 1997 are excellent.
In the next issue of the ASA NEWSLETTER, Janée
Bonner, ASA Federal Affairs Coordinator, will summarize the election
results, particularly in light of what they portend for Medicare
legislation in the coming year.
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