HCFA: Physician pay delay essential
HCFA: Physician pay delay essential
Agency says year 2000 changes a priority
Last month, Physician's Payment Update reported HCFA was considering a delay in scheduled physician reimbursement adjustment in order to divert staff time and funds to make its computer systems ready for the year 2000 and beyond. Since then, HCFA administrator Nancy-Ann Min DeParle has taken that message to Congress.
Restating the same basic arguments she made in a June 16 memo to her bosses at the Department of Health and Human Services, DeParle told federal lawmakers she intends to delay implementation of several scheduled new payment methodologies to ensure HCFA's computer systems are year 2000-compliant.
Upgrading Medicare's computer codes to year 2000 specifications has turned out to be "a lot more difficult than we had thought," DeParle told a July 16 hearing of the the House Ways & Means Health Subcommittee. The job will prove more than twice as difficult, in fact, as she says the agency and its contractors must rewrite 50 million lines of code - up from a previously estimated 20 million lines - to ensure HCFA's software is safe from the year 2000 computer bug.
To guarantee it has the resources to finish the job and still be able to process Medicare claims, HCFA plans to postpone several new computer-intensive programs scheduled for implementation, including physician fee schedule increases, consolidated physician billing, selected Part B services in nursing homes, outpatient health care, and home health prospective payment systems.
Rather than Jan. 1, 2000, HCFA wants to delay these program changes until at least April 1, 2000.
"These activities are being postponed because they involve complex systems changes and interactions with other systems at the very time such activity would interfere with critical y ear 2000 work," DeParle testified. "We will work with Congress and providers to evaluate our options and ensure that any necessary delays in provider updates do not create a hardship. And we will work with this committee to evaluate the legislative changes that may be needed. "
Healthcare Subcommittee Chairman Bill Thomas (R-CA) was not happy with DeParle's plan to postpone these programs. "In recent months, the White House has announced a number of health care initiatives," said Thomas. "The administration clearly has time and resources for its own priorities, but is neglecting initiatives already enacted into law."
"It is incomprehensible to me that this year 2000 problem has gotten so far out of hand," echoed Pete Stark (D-CA), the subcommittee's ranking Democrat.
Physician groups also are concerned about this situation. Doctors and hospitals should not have to "pay for government's mistakes by settling for a delayed payment update," said Donald J. Palmisano, a trustee of the American Medical Association.
HCFA officials say the agency is "making substantial progress" in getting all of its 98 mission-critical information systems updated. However, the provider lobby is pushing for more concrete details and a commitment from the agency to unveil contingency plans designed to minimize any disruptions caused by a delay in payment.
"This issue is about more than dollars," said Harold C. Sox, MD, FACP, president of the American College of Physicians-American Society of Internal Medicine in Washington, DC. "It involves questions of whether or not physicians and beneficiaries can have confidence that the Medicare program will be able to - and will - meet its obligations to physicians and Medicare patients in the year 2000 and beyond."
In turn, ACP-ASIM has asked HCFA to clarify:
- which updates and payment changes would be delayed, and what impact this might have on implementation of annual fee schedule updates and resource-based practice expense payments;
- how physicians will be held harmless from the cumulative impact of the delay, i.e., how the compound impact of a lengthy delay in the increase in payments for office-based primary care services will be made up to physicians at a later date.
The preliminary word coming from HCFA is that it intends to make up any postponed payment updates by April 2000, but it does not want to pay any interest penalty for the delay.
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