Look for these budget trends to hit your wallet
Look for these budget trends to hit your wallet
PSOs, preventive services favored
Interviews with various physician groups and Capitol Hill sources have identified key physician-related provisions contained in the federal budget resolution that now must be debated and perhaps revised before being finalized by the appropriate legislative authorizing committees.
On the good side of the balance sheet, the following items appeared likely budget additions:
• Child health care. $16 billion will be appropriated for health care for children of the working poor.
• Low-income access. Increase federal low-income Medicare premium subsidies to include individuals at 150% of poverty level, up from 120%. This amounts to $1.5 billion in new spending.
• Preventive services. Expand Medicare coverage for such preventive services as colon screening, diabetes self-management, flu shots, and immunizations.
• 50-50 rule. Liberalize the current 50-50 commercial-to-Medicare HMO enrollee rule.
• Medicaid. Restore Medicaid benefits to legal immigrants.
• PSOs. Encourage creation of provider-sponsored organizations (PSOs), such as physician service networks and preferred provider organizations, that contract with HCFA for Medicare members. Expect a fight in committee over wording and details of related licensing and solvency standards, with HMO and hospital groups wanting to keep the bar high.
But not everything is rosy. In addition to the likely health care expenditures outlined above, physician practices will probably have to face cutbacks in these areas:
• Single-surgery fees. Medicare fees are reduced for surgeons that use an assistant when operating. The reduction is greater if the assistant is a doctor instead of a nurse practitioner or physician assistant. The effective pay cut could be anywhere from 10.4% to 16%.
• AAPCC. Starting in 2000, adjusted average per capita cost (AAPCC) payments, which vary provider payments by geographic region, drop from 95% of fee-for-service spending to 90%. This shaves some $6 billion off projected HMO payments over five years.
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