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Tacts about the Medicare Program Problems

Remedies ooding year. But annual increase It is the Secretary who dein prevailing charge is limited cides "similar services," to a fixed percentage cap, an "locality," & appropriate goononic index, reflecting

"economic index." obangos in expenses of practice Federal guidelines require A proper mix of all charges and changes in general earnings that in determining reason- by doctors would result in more lovolo.

able charge, consideration equitable reasonable charge &

must be given to doctors'

higher reimbursement.

Source of data is controlled

by HCPA and the carrier.

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facts about the Medicare Program Problems

Data groupings present problem:

data of charges by specialists &

changing patterns vary too much

between carriers for overall com

parison. If errors exist they are
probably in the mix of specialties
and in mix of general practitioners

and specialists.

Congress could change law

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index as determined by Secy.

lative history for single nation. Congress could presaure DHHS

wide index. In fact, legisl. hist- into setting inflationary ory shows that Congress wanted cap at a level commengurato

use of several economic indexes.

with actual health care cost inflation rate. strong geographic variations in

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Consultant's 1980 report shows

cost of mal-practice insurance,

non-physician labor expenses, &

Index has great

er effect in limiting reimburse

ment in northeast & west than in

N.J. 18 not getting its

40% - 60% weights inappropri

on both regional basis &. on

In dealing with general earn

ings levels, it is unfairly limite

ed. It does not cover other seg

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al, agricultural, technical, etc.

Earnings of those drs, whose charges

continue to rise above reasonable

charge are not considered in measure

hots about the Medicare Program Problems

housing costs.


fair share.

Index is based on changes in


types of doctors' practice.

exy DHCA of practice (given 40%
weight) and changes in general
warnings of production & super-
visory sorkers (given 60% wt.)

ments of labor force

ment of inflation.

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cost of medical practice.

Only about 50 % of doctors (in At the least, the law pro-
New Jersey
Sopot 52**) accept assignment;

vision that there will be no
1.e., agree to accept"reasonable interference with fees charged
charge"as their charge to patients, by dodoties should be elimin-


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