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.

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