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Fam Pract Manag. 1998;5(7):27

RBPE proposal means smaller gains for primary care doctors

HCFA has unveiled its latest proposal for a resource-based method of determining the practice-expense component of Medicare reimbursements. Although the change will likely mean somewhat higher payments for family physicians, the payments won't be as high as they would have been under last year's practice-expense proposal from HCFA.

Because the practice-expense component of Medicare payments is currently based on doctors' historical charges, procedural specialists have been receiving much higher reimbursements for their practice expenses than have primary care physicians. Since 1994, HCFA has been developing a new system that will base payments on the relative value of resource-based practice expenses (RBPEs).

The RBPE system that HCFA proposed last June was a “bottom-up” approach that would have based practice-expense payments on the resources actually needed to provide a service, says Laura Saul-Edwards, an AAFP government relations representative. Payments to primary care physicians would have increased significantly, and payments to procedural specialists would have dropped. But pressure from procedural specialists led Congress to head off the proposal and to delay implementation of RBPEs.

HCFA's latest proposal is not resource-based, Saul-Edwards says. Instead it takes a “top-down” approach, basing practice-expense payments on the total current practice expenses reported by physicians. “Doctors in higher-paid specialties obviously can afford to spend more on their practices because their services are overvalued and overpaid under the existing, charge-based system,” Saul-Edwards says.

As an example of the likely increases under the revised proposal, the practice-expense payments for 99213 visits would rise almost 23 percent less than they would have under last year's proposed system, Saul-Edwards says.

The Academy is lobbying against the new RBPE proposal, which appears in the June 5 Federal Register. HCFA will accept comments on the proposal until Sept. 3. The new system will be phased in over four years beginning in January 1999.

Quote. Endquote.

“If we don't reverse the current trends, by the year 2023, we won't have any members at all.”

E. Ratcliffe Anderson Jr., MD, the AMA's new executive vice president, on the organization's renewed efforts to recruit and retain members. Just 36 percent of American physicians belong to the AMA today; 75 percent were members in the 1960s.

Wolinsky H, Manor R. New AMA boss aims to hike membership. Chicago Sun-Times. June 15, 1998.

HCFA turns to citizens, contractors to find fraud

HCFA's new slogan for fighting fraud and abuse might be “crime doesn't pay — unless you turn someone in.”

The agency recently announced that people who report possible fraud and abuse will be eligible for rewards if their information leads directly to the recovery of Medicare funds. Individuals will be able to receive 10 percent of recovered overpayments, up to a maximum of $1,000.

The reward program will take effect in January 1999. Details appeared in the June 8 Federal Register.

In addition to the reward program, HCFA will be hiring private contractors to help the agency uncover fraud and abuse. Until now, Medicare carriers have been responsible for activities such as auditing providers and conducting medical-necessity reviews. But by early 1999, HCFA will contract with other private-sector firms that “can bring new energy and ideas” to fraud and abuse detection, according to the agency.

The authority for both anti-fraud measures comes from the 1996 Health Insurance Portability and Accountability Act.

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Copyright © 1998 by the American Academy of Family Physicians.

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