August 2000 • Volume 6 • Number 8
Resource-based practice expenses
'Halt 2000' proposal would derail RBPEBY JANE STOEVER
Forty-some surgical groups are trying to take the steam out of resource-based practice expenses. The Academy and seven allies have come to RBPE's defense, wanting it to keep chugging toward its 2002 destination.
The surgical groups' proposal, "Halt 2000," would stop at midpoint the 1998-2002 transition toward using 100 percent RBPE for calculating Medicare payments.
Why the halt? To keep surgical specialists' share of the Medicare pot from shrinking.
The AMA House of Delegates adopted the Halt 2000 resolution June 14, despite strong opposition from the Academy and its partners in the Practice Expense Fairness Coalition. By press time, the coalition had succeeded in helping prevent Halt 2000 from being added to congressional bills.
The coalition represents more than 350,000 family physicians, pediatricians, internists, dermatologists, oncologists, osteopaths, rheumatologists and nephrologists.
What are the differences between the full RBPE at 2002 and Halt 2000? Two things: The new proposal has a $2 billion price tag and would wreck a carefully designed process. Practice expenses were reimbursed in 1998 according to historical charges that favored surgical services. Congress approved a gradual transition to RBPE based on data confirming that costs for overhead, staff and supplies for office-based services were underpaid.
Halt 2000, in a bow to primary care, calls for 19 Medicare codes for office visits/consultations to jump in 2000 to their expected 2002 levels. But thousands of codes would remain at their 2000 levels.
"If we approve Halt 2000, we continue the inequities of the historical charge-based system," Douglas Henley, M.D., told an AMA reference committee. He is an AAFP past president and the Academy's new executive vice president.
On June 21, AAFP President Bruce Bagley, M.D., of Albany, N.Y., wrote the House Ways and Means Committee: "Please understand that the Halt 2000 proposal not only divides medicine, but would encourage the groups that advocate it to continue to come to Congress each year for more modifications. By contrast, if we stay with full implementation of RBPE, the Congress need not reconsider the issue. A fair process will be in place that can be refined as necessary without congressional involvement each year."
On June 26, the Practice Expense Fairness Coalition encouraged Congress to continue the transition to RBPE. The coalition suggested that if there are additional funds for Medicare physician payments, Congress should commit $2 billion to increasing all physicians' payments by about 3 percent over the next two years. How? By increasing the conversion factor used to set the Medicare fee schedule. This across-the-board solution would maintain RBPE intact. Funds could come from the budget surplus. And all specialties would receive a 3 percent increase instead of having the some-win-some-lose result of Halt 2000.
Go to http://www.aafp.org/gov for a sample e-mail/letter urging Congress to support the full RBPE transition and an increase in the Medicare conversion factor. Click on "Speak Out," then on "Write to Congress," then on "Support Fair Payments for ALL Physicians!"
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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