News Briefs

Health Care Financing Review, Fall, 1999

CONFERENCES SCHEDULED

AAAS Annual Meeting to Be Held in February

The 166th national meeting of the American Association for the Advancement of Science (AAAS) Annual Meeting and Science Innovation Exposition will be held in Washington, DC, February 17-22, 2000, at the Washington Marriott Wardman Park and the Omni Shoreham.

This annual meeting will bring together more than 5,000 scientists, engineers, educators, policymakers, and researchers in a multidisciplinary forum to share the latest research advances.

This convention will feature more than 150 scientific symposia; specialized seminars; topical, plenary, and award lectures; poster sessions; an exhibition hall; field trips, career workshops; and a science career fair.

For more information, contact AAAS at 202-326-6450; fax: 202-289-4021; e-mail: confinfo@aaas.org.

RECENT HEALTH CARE DEVELOPMENTS

Medicare Proposes 2000 Physician Fee Schedule

The Health Care Financing Administration (HCFA) published a proposed physician fee schedule for calendar year 2000 that continues the transition to a fairer physician payment system.

Continuing the reforms initiated in the 1999 fee schedule, the 2000 Medicare physician fee schedule relates payment for physician practice expenses to the actual resources used to provide medical services rather than physicians' historical charges.

"Breaking the link between Medicare practice expense payments and historical charges will create a fairer payment system," said HCFA Deputy Administrator Michael Hash. "The proposed 2000 fee schedule represents an important next step in making sure Medicare pays physicians fairly. By refining the payment system to be more equitable, we help Medicare beneficiaries to stay healthy and productive by preserving access to physicians."

HCFA published the proposed regulation in the July 22 Federal Register. The final version will be published in the fall.

The fee schedule specifies payments to physicians for more than 7,000 services and procedures, ranging from routine office visits to cardiac bypass surgery. In 2000, Medicare will spend about $37 billion on physician services.

Under the proposed fee schedule for calendar year 2000, physicians who provide services primarily in office settings, such as family practice and internal medicine specialists, would receive slightly increased payments, while physicians who provide services primarily in the hospital setting would receive slightly decreased payments. However, because of the malpractice insurance cost adjustments, emergency department physicians would receive a 2.7-percent increase and nephrologists a 1.3-percent increase. No specialties are expected to receive payment decreases or increases greater than 1 percent.

The resource-based practice expense component of the Medicare fee schedule is being phased in during a 4-year transition period that began January 1, 1999. Payments under the 2000 fee schedule will be based on a blend of 50 percent of the resource-based practices expenses and 50 percent of the old, charge-based system. When the resource-based practice expense is fully effective in 2002, all components of the fee schedule, including physician services, malpractice insurance expense, and practice expense, will be resource-based, creating a more equitable system.

The proposed rule would implement the resource-based malpractice relative value units required by the 1997 Balanced Budget Act. Using data on how much various medical specialties spent on malpractice insurance, HCFA adjusted each service for the cost of malpractice insurance associated with it. This adjustment is not expected to have a significant effect on overall payments made to various medical specialties.

Also, Medicare coverage would be extended for prostate screening tests for all male beneficiaries effective January 1, 2000. President Clinton's June 29 proposal to modernize Medicare contained a proposal to eliminate all coinsurance and copayments associated with health screening tests. Prostate cancer is the most commonly diagnosed cancer in males and the second leading cause of death from cancer among American males.

The new payment rule was prompted by studies that showed that the old charge-based system did not fairly compensate physicians for practice expenses. For example, under the old system, coronary bypass surgery would receive practice expense payments more than 100 times greater than those for an office visit, although costs for bypass surgery are only about 40 times higher.

Before implementation of the fee schedule in 1992, Medicare based payments on each physicians charges. The fee schedule was created to relate payments to the resources physician's use to provide a service rather than what physicians charge for a service.

New Drug Regimen Helps Prevent HIV Infection in Infants

A joint Uganda-U.S. study has found a highly effective and safe drug regimen for preventing transmission of human immunodeficiency virus (HIV) from an infected mother to her newborn that is more affordable and practical than any other examined to date. Interim results from the study, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), demonstrate that a single oral dose of the antiretroviral drug nevirapine (NVP) given to an HIV-infected female in labor and another to her baby within 3 days of birth reduces the transmission rate by one-half compared with a similar short course of Azidothymidine (AZT). If implemented widely in developing countries, this intervention potentially could prevent some 300,000 to 400,000 newborns per year from beginning life infected with HIV.