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 Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto

October 21, 1998

Health Care Financing Administration
Department of Health and Human Services
Attention: HCFA-1005-P
P.O. Box 26688
Baltimore, MD 21207-5178

Re: PROPOSED RULE HCFA-1005-P

To Whom It May Concern:

The Association of American Physicians and Surgeons ("AAPS") hereby submits its comments to the proposed rule to implement a prospective payment system for hospital outpatient department services (63 Fed. Reg. 47552 (Sept. 8, 1998)).

AAPS is a not-for-profit membership organization that represents thousands of physicians in all practices and specialties. It was established in 1943 to preserve the practice of private medicine, and has remained dedicated to the Oath of Hippocrates and protecting the sanctity of the patient-physician relationship. It is incorporated in the State of Indiana and is tax-exempt under Section 501(c)(6) of the Internal Revenue Code.

AAPS objects to the Proposed Rule with respect to its utilization of a small number of ambulatory payment categories (APCs) for all cancer chemotherapy, bundling the costs of drugs and biologics into the single payment, because of its significant adverse consequences for cancer patients.

The use of a small number of APCs fails to recognize the complexities of cancer chemotherapy, and the widely varying needs of individual patients. As a result, the proposal will create financial incentives that will inevitably lower the quality of care available to these patients.

The overall effect of prospective payments in particular, and price controls in general, is to force medical professionals to base treatment decisions on pressures unrelated to the patient's best interest, or to become financially nonviable.

In general, AAPS also objects to regulations that constitute the functional equivalent of the practice of medicine by an administrative agency because of the practical effect in dictating either the procedure to be performed or the setting in which it is to be performed. These are properly issues left to the professional judgment of the physician directly responsible to the patient. Moreover, HCFA's interference by these means is a violation of the letter and spirit of the act that established Medicare:

§ 1801. Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which Medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.

AAPS encourages HCFA to rescind the proposed rule and to refrain from making changes that will erect more barriers between patients and physicians, and between patients and the medical care of their choice.

Sincerely,

Jane M. Orient, M.D.
Executive Director