The Trials of Medicare Physician Payment Reform

Abstract

IS MEDICARE physician payment reform in jeopardy? Physicians' organizations, including the American Medical Association (AMA), specialty societies, and state medical associations, have expressed alarm about the content of the Notice of Proposed Rulemaking (NPRM) that was published on June 5 by the Health Care Financing Administration (HCFA) to implement the Medicare Fee Schedule. For editorial comment see p 1566. What are the problems that are causing so much concern among physicians? Did physicians misinterpret the 1989 legislation that reformed physician payment? Or did HCFA propose rules that do not reflect the intent of Congress and fall short of physicians' expectations concerning accurate resource-based relative values? In this Commentary, we discuss these issues from the perspective of the Physician Payment Review Commission (PPRC). <h3>Background</h3> In December 1989, Congress passed a comprehensive physician payment reform for Medicare that included a resource-based fee schedule, limits on balance billing, and a mechanism to update