United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1998-02-27 monographic deposited born digital 59 p. GA 1.13:HEHS-98-79 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-79 P0b002ee18038b0f8 f:he98079 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-98-79 machine generated eng fdlp REPORT GAOREPORTS-HEHS-98-79 HEHS-98-79 Health care programs Medical fees Malpractice (medical) Medical services rates Proposed legislation Health care costs Medical economic analysis Physicians Overhead costs Statistical methods Medicare Program Letter Report HEHS Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) proposed practice expense revisions and its ongoing efforts to refine its data and methodologies, focusing on: (1) HCFA's approach for estimating the practice expenses directly associated with each medical service or procedure; (2) two methodologies HCFA used to adjust the direct expense estimates; (3) practice expenses excluded or limited by HCFA; (4) HCFA's method for assigning indirect practice expenses to each medical service or procedure; and (5) the potential impact of the new fee schedule allowances on beneficiary access to care.<p/>GAO noted that: (1) HCFA used expert panels--consisting of physicians, administrators, and nonphysician clinicians--to estimate the direct labor and other direct practice expenses associated with medical service or procedures; (2) GAO explored alternative primary data gathering methods, such as mailing out surveys, using existing survey data, and gathering data on-site; (3) GAO concluded that each of those methods has practical limitations that preclude its use as a reasonable alternative to HCFA's use of expert panels; (4) gathering data directly from a limited number of physician practices would, however, be a useful external validity check on HCFA's practice expense rankings and would also help HCFA identify refinements needed during phase-in of the fee schedule revision; (5) the panels' estimates of direct practice expenses needed several types of adjustment; (6) GAO found problems, however, with one of HCFA's adjustment methods, which substantially altered the practice expense rankings; (7) specifically, HCFA used a statistical model to reconcile significant differences among various panels' estimates for the same procedure; (8) GAO identified technical weaknesses in the model that may have biased the estimates; (9) HCFA excluded some physician practice expenses from the panels' estimates because it believes that Medicare pays for those expenses through other mechanisims; (10) physician groups, however, argue that shifts in medical practices have resulted in physicians absorbing these expenses; (11) HCFA also placed upper limits on the panels' administrative and clinical labor estimates; and although these limits seem reasonable to HCFA, they are not supported by any data or analysis; (12) HCFA's method for assessing indirect expenses to medical procedures is acceptable--there is no single best way on the basis of each procedure's total relative value units (RVU) for physician work, direct practice expenses, and malpractice expenses, factors that likely reflect some of the variation on the ratio between direct and indirect expenses among physician specialties; (13) however, the survey data collected by a physician organization might provide more straightforward estimates of specialty--specific indirect cost ratios, and that organization is willing to expand its survey for HCFA's use; and (14) the 1992 implementation of the fee schedule resulted in lower Medicare payments to some medical specialities, but subsequent studies found that Medicare beneficiaries' access to care remained very good. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-79/html/GAOREPORTS-HEHS-98-79.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-79/pdf/GAOREPORTS-HEHS-98-79.pdf GAO/HEHS-98-79 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-79 Letter Report GAO/HEHS-98-79; Medicare: HCFA Can Improve Methods for Revising Physician Practice Expense Payments; Health care programs Medical fees Malpractice (medical) Medical services rates Proposed legislation Health care costs Medical economic analysis Physicians Overhead costs Statistical methods Medicare Program Volume 100 Page 82 100 Stat. 82 Volume 103 Page 2106 103 Stat. 2106 Volume 108 Page 4398 108 Stat. 4398 Volume 111 Page 251 111 Stat. 251 Public Law 99-272 Public Law 101-239 Public Law 103-432 Public Law 105-33