European Stars And Stripes (Newspaper) - May 9, 1988, Darmstadt, Hesse                                Doctoring up medical fees Bull Freudenheim new York times s part of the Dovolo gain Eon Lrol of sharply rising spending on doctors services in Iho a Nilert slaves the government is creating a new system Hal Mill drastically alter Many medical Lees. The system which would assign a relate pc value Lor Al medical services is being devised for medicare Trio health insurance program Lor 33 million elderly and disabled americans the new system has provoked open scepticism in some medical quarters and vigorous support in others. The american medical association and most other medical groups have accepted the concept they Hope that by agreeing to a new Loo of Sacra they Wil be Able to Dellel proposals to restrict their ability to charge patients More than what medicare will pay although in May be As Long As two years before the system is operating Puvalo health insurance plans Are Likely to follow medicare 1 Lead and adopt in Tor their payments under the nou system Ihn Gross income of family practitioners and internals May increase 20-30 percent whiff the Gross income of general surgeons May drop 20 Pyrc Cal according to economists and physicians developing the system. The projections which were described As preliminary bul arc note Pontod to change radically were pose nod at a meeting of medical representatives Al Harvard University last month by or William c Hsiao an economist Dirc cling the Woik the value of each procedure or service from open hear surgery to a Visil to a family practitioner will be based on such factors As the required skill judgment and time spent Iro Aling a pal incl Puvalo and government spending on physicians services exceeded $100 billion Las year with employers paying about a third. Medicare contributed $22 billion. All physicians won t like in because there will be gainers and losers said Paul b. Ginsburg executive director of the physician payment Boliew commission which was established by Congress in 1s85, the 13-member commission which includes is physicians has endorsed the relative value system approach. The current method of medicate payments which has been widely criticized by physicians and patients is based on what Aie known a Cus Lamary prevailing and reasonable Lees in various localities. The payments Mado by medicare or private health insurance Are based on analysing the pattern of Lees rather than analysing the procedures themselves but the new Myslem. Being prepared in a $2 million cider Al study at the Harvard school of Public health would assign a value to each medical procedure. Medicare would then assign a Dollar value to a unit on the scale creating a unified fee schedule. The new system is expected to narrow the Gap Between the relatively High payments Lor procedure performed by such specialists us radiologists surgeons and Palolo girls end the Radil tonally smaller fees of counselling and diagnosis charged by paediatricians internists and family practitioners among others. Federal budget restraints make increasing the total unlikely except to keep Pace with inflation and growth in the elderly population. The size of the pie Ain t going to  Jamos h Sammons executive vice president of Iho Amei Icari medical association Lold slate medical society officials recently. The new system was ordered by Congress last year loll cling increasing i Squill about using Federal health care costs Wilhour waiting for the relative value scale.  it the government la creating a new system oat will drastically altar Many mad few Leas in the United St Lei. Congress ordered cuts ranging from 2 percent to 15 percent in the medicare payments Lor 3 surgical procedures. They include Cataract removal coronary Ailery bypass and hip replacement prior to the cutback Onca Maracl Lees medicare was paying to million a year to one or More ophthalmologists in most every state said Kevin a Molcy. A senior medicare Oll cml. Heralding the trend toward realigning Lees con teos in december also increased medicare payments for primary health care such As Ofhie visits or. William l. Roper the medicare administrator said he did not expect the new fee schedules alone to curb inflation of medical costs nor will they slow the rapidly increasing volume of physician services performed each year to said. The american medical association is backing the Harvard approach As a Way to establish some sort of Benchmark said James s. Todd senior Deputy executive vice president of the association but in no Way should ilbo considered a fixed mandatory reimbursement  he said Lees should not to limited to medicare ceilings except for patients who Are poor. Iii am a physician who chooses to provide a special parking sol a posh waiting room and increasingly sophisticated equipment in my office he said then clearly i should be entitled to charge Lor those  similar medical Lee systems Are already in of acl in Canada and most Western european countries William a Glaser. A professor of health services of the new school Lor social research said Many state medical societies and specially groups also had fee schedules until the Federal Trade commission ruled in the 1970s that they illegally restrained Competition. The Dif lord acc Between what medicare pays in Manhattan Lor an Mollico visit and a surgical procedure illustrates the issues the new system would address. Medicare now pays $30-40 in Manhattan Lor a comprehensive Ollice visit to an internist or other specialist ii pays $1or 15 limes As much Lor an appendectomy performed by a surgeon. The office visit May take 45 minutes. An appendectomy Lor an elderly patient might require nine or More hours including postoperative Allenton. For a patient Wilh complications. 30 hours might be needed according to it Ellrey s freed an ass Island clinical professor of surgery at the mount Sinai medical Center school of Medicine. The implications of the relative value approach Wom a Piunt in a study Whoso results were published last summer in the journal heart affairs the study fount Hal to Caig had set a reasonable charge Lor hip Rcpt Aumont Al $2,040. Using a hypothetical relative value system. The payment would have been Only �1.12-1. The study headed by Janet a Mitchell of the conto Lor Halih economics research a non profit group in Needham Mas was based on average Lees in 1384 in Alabama. Connecticut. Wisconsin and Washington stale under the current medicare reimbursement system doctors payments vary widely around the country and. In some slates according to which specialist did the work. There is a consensus Hal the customary regular and prevailing Way of paying physicians is a mess said Olha w. Union a spokesman Lor the american College of radiology a professional association. However the radiologists whose incomes average among Iho highest have sharply criticized Iho work at Harvard. In a letter March 30 the radiologists protested to Hsiao citing concerns about the Mol hods used in collecting and evaluating payment data. In january the Massack Solts medical Sociol accused Hsiao of Bias. The society said his Carter work had assumed Hal physicians Are unscrupulous and Pra Clicc Medicine in a fashion that furthers their own economic inheres is without regard to what is in the bos i interest of Chr air  bul even some of Iho strongest critics soem to be coming around to accepting the Rel alive value concept la s  said , Siragusa jr., a Obs Elucian  who is president of the Massachusetts medical society to added that he was now Sali Slid Hal Hsiao would Deal fairly Wilh physicians concerns y 9,1983 the stars and stripes Page 15