MEDICARE: FEE DISCREPANCY SPURS CALL FOR FEDERAL REVIEW

      A "wide discrepancy in county-to-county" Medicare fees "has
 prompted some consumer groups to call for a federal review of the
 Medicare fee system," DETROIT NEWS reports.  According to the
 Health Market Survey's list of per patient Medicare fees for the
 nation's 22 most expensive counties, the discrepancy between the
 most and least expensive county is $208.08.  Stephen Zuckerman, a
 health care economist for the Urban Institute, said that the fees
 "are influenced by physician wages, rent, malpractice insurance
 and other factors."  However, DETROIT NEWS reports that critics
 contend that "there should be more uniformity to" the fees. 
 Terry Brooks, a health care attorney in Washington, DC, said that
 the fee discrepancy is a "major, major issue."  Congress has
 scheduled hearings on the fee discrepancy issue for the spring.
      UNRULY SYSTEM:  Currently, Medicare fees for health care
 services are set on the national level "and then adjusted at the
 county level to account for differences in related health care
 costs, such as the cost of living and malpractice insurance." 
 However, Bill Boyles, editor of Health Market Survey, a
 Washington, DC, trade publication that covers the managed care
 industry, questioned the fee discrepancies.  He said, "Are the
 doctors providing higher quality services?  They are spending too
 much and prescribing too many unneeded services ... that's the
 only answer." 
      TOP SPENDERS:  Richmond County, New York tops the list
 spending an average $767.35 per patient.  Dade County, Florida
 comes in second at $748.23, followed by Bronx County, New York at
 $728.24.  New York and Kings counties in New York follow at
 fourth and fifth, respectively.  Philadelphia County,
 Pennsylvania placed sixth, spending $704.25; Los Angeles County,
 California ranked 11th at $622.55.  And Cook County, Illinois
 placed 22nd, spending $559.27.  DETROIT NEWS reports that the
 national average of county Medicare fees is $488.25  (see AHL
 9/9) (Raphael, 9/22).