Document Title
Practice Expense Payments for Resource Costs (HR 3859). Letter to U.S. House of Representatives.
Author
Nelson, Alan R., MD, MACP. Cohen, H.
Keywords
Insurance, Health, Reimbursement;Medicare;Rate Setting and Review;Resource-based Relative Value Scale;United States Health Care Financing Administration
Creation Date
Modified Date
Pages
1
Document
practice_expense_payments_resource_costs2_hr_3859_1996.pdf
Adobe Metadata
{"Author":"Nelson, Alan R., MD, MACP. Cohen, H.","Producer":"Acrobat 4.0 Scan Plug-in for Windows\u0000","Creator":"Acrobat 4.0 Capture Plug-in for Windows\u0000","Keywords":"Insurance, Health, Reimbursement;Medicare;Rate Setting and Review;Resource-based Relative Value Scale;United States Health Care Financing Administration","ModDate":"2001-02-07T16:09:57-08:00","Abstract":"In 1994, Congress mandated that the Health Care Financing Administration develop a resource based methodology for reimbursing physicians for their practice expenses, for implementation in 1998. Congress recognized that the current methodology has resulted in inequitable Medicare payments that have no rational relationship to actual differences in the costs of providing physician services. To illustrate, a primary care doctor would have to provide 115 mid-level office visits before receiving the amount of practice expense reimbursement that a surgeon receives for a single triple bypass graft in the hospital--even though Medicare is already paying the hospital under Part A for the nursing staff, equipment, supplies, operating room expenses, and the other direct costs it incurs for the surgical procedure. No such assumption of cost by the hospital or any other health care provider exists with regard to practice expenses borne by internists as they care for Medicare patients. At a time of severe fiscal constraints on Medicare, it makes absolutely no sense for the program to pay the hospital under Part A, and the surgeon under Part B for the same direct practice expenses incurred in providing a surgical procedure--while reimbursing primary care physicians at rates that barely cover overhead costs.","Title":"Practice Expense Payments for Resource Costs (HR 3859). Letter to U.S. House of Representatives.","DocType":"Formal Statement","CreationDate":"2001-02-07T16:09:35-08:00","DateApproved":"1996-07-26","Pages":1}
Document Type
Letter
Year
1996