June 1997 AAOS Report
HCFA considers practice expense tranistion, delay
Officials at the Health Care Financing Administration (HCFA) are
debating whether to actively seek a prolonged transition period
or a delay in implementing a proposed resource-based practice
expense value system on Jan. 1, 1998. The resource-based payments
for practice expenses could reduce reimbursements to orthopaedic
surgeons by 9 to 16 percent. Despite misgivings about its data,
HCFA has not been willing to ask for a delay in the start-up date
which was mandated by Congress. Bruce C. Vladeck, PhD, HCFA administrator,
told the April meeting of the National Orthopaedic Leadership
Conference that he is not satisfied with the research and development
work on the resource-based practice expense system. Vladeck admitted
that "the work is not as complete as we like it. It is limited
in a number of significant ways. The fact is that this is not
only an area in which it turns out we knew or know a lot less
than we thought we did at the time that Congress enacted the legislation,
it's an area in which is extraordinarily difficult to get reliable
information on a statistically sound basis" Rather than delaying
the practice expense payment system, Vladeck favors refining it
over two or three years and would work with medical specialties
to develop needed information.