Mark Crane

Doctors say, and do, the darndest things 

Some responses to our lifestyle survey were a   bit bewildering, amusing, or perhaps frightening, depending on your point of   view.  

Okay, we assume that most physicians are honest about filling   out survey questionnaires. So we're taking them at their word when they describe   their political and religious beliefs, along with the lifestyle choices they   make. Still, we wondered about some of the responses, the ones that had a few   of us scratching our heads, saying, "Who would have thought that?" 

 Now we realize that some folks may take perverse pleasure in   zinging inquisitors who ask exceptionally nosy questions about their sex lives,   television viewing habits, and susceptibility to vice. For example, to our question   of what you would do with an extra $100,000, one physician came back at us with,   "Send it first. Then I'll tell you." In response to questions about sex, a few   doctors wrote back, "None of your business." 

 We also realize that in a survey of more than 2,000 physicians,   there are bound to be a few "outliers" who march to their own drummer. Nevertheless,   some respondents offered us truly unexpected answers. A sampling: 

 "Answering questionnaires" is one response we got to the question, "What     is the No. 1 activity you do with your nonwork time?" Another said, "If I'm     not fishing, I cut wood for people's fireplaces."

One physician donated $20,000 for an animal sanctuary. Another gave $50,000     to the National Rifle Association.

One gun enthusiast owns an AK-47 along with a slew of rifles, handguns,     and shotguns. 

 Beyond the individual responses, here are a few numbers that   especially surprised us. 

 of psychiatrists don't watch televisionat   all. 

 (all of them men, in several specialties)   say 

 (two men and one woman) say the daytime   soap opera 

. We hope they're watching with their kids or grandkids, but who knows?   (On a positive note, none of our respondents listed the 

 was the   book that had the greatest impact on their lives. 

 smoke cigars (though no women   in our survey are pipe smokers). 

married or are living with attorneys,   12 with artists, and three with actresses. 

 say Nevada gambling resorts are the   perfect vacation spot. 

 

Mark Crane. Doctors say, and do, the darndest things. 

Articles

Some responses to our lifestyle survey were a bit bewildering, amusing, or perhaps frightening, depending on your point of view.

Doctors say, and do, the darndest things

Getting personal:	 Who is today's doctor, anyway? 

Our comprehensive national survey explores the ways physicians   live and think when they're not at work. 

Volumes have been written about physicians' harried professional lives. But   once outside the office or hospital, how do doctors spend their time? What do   they love, hate, and fear? Are they content with the balance between their private   and work lives? Is there such a thing as a "typical" physician? 

To find out, we conducted a comprehensive survey of physicians' lifestyles. Earlier this year, we invited 10,000 randomly selected doctors to answer an admittedly intrusive questionnaire. More than 2,000 doctors from all major fields in every part of the country responded, providing intimate details about their personal likes and dislikes, including political and religious beliefs, family life, susceptibility to various vices, musical tastes, recreational preferences, and much more.

What emerges is a portrait of the modern American doctor that seems predictable in some ways, surprising in others. There were many similarities in physician attitudes and lifestyle choices compared with our last survey back in 1979, but also some dramatic differences.

Perhaps it's presumptuous to attempt to define the essence of more than 750,000 diverse individuals who make up the medical profession. However, certain themes and beliefs were fairly consistent and allow us to make reasonable conclusions about today's doctorwith some notable exceptions.

 The "typical" physician is serious, responsible, and conservative in both   his politics and lifestyle choices. That's hardly news. But he's much more inclined   than physicians of previous generations to think that being a good parent and   spouse is just as important as being a successful professional. Here's a snapshot   of other things we found out: 

 86 percent of the physicians we surveyed are marriedfor 20 years,     on average.

An astounding 93 percent rate their marriages as terrific or good. Still,     one in five has gone to marriage counseling, and 12 percent admit to having     had an extramarital affair. Back in 1979, there were twice as many physician     adulterers.

Three-quarters of physicians say their sex life (a median of five times     per month) is satisfactory.

88 percent of physicians have children. Eighty percent of male physicians     say their wife is the primary caretaker. For women, only 20 percent can rely     on their husbands to do the heavy lifting of parenthood. One-third of physician-moms     take care of the kids themselves.

78 percent of doctors say they're very satisfied with the experience of     being a parent.

79 percent of physicians are at least somewhat satisfied with the way they     balance work, family, and personal needs.

Nearly 87 percent of doctors believe in a supreme being. When we asked the     same question in 1979, the percentage was 74. About 40 percent of physicians     today are actively involved in their house of worship, and say that religion     is very important to their daily lives.

The book that had the greatest impact on their lives is the 

Politically, 43 percent of physicians call themselves conservative, followed     by 39 percent moderate, and 15 percent liberal.

Almost one-third of doctors own firearms.

Two-thirds of doctors drink alcoholic beverages. Only 3 percent smoke cigarettes.     Another 5 percent smoke cigars or pipes.

84 percent of doctors say they've never used marijuana or other illegal     drugs, and less than 1 percent say they currently engage in illegal drug use     for recreational purposes.

Physicians don't get out much. Few regularly attend movies, concerts, or     sporting events. And most doctors spend little time in front of a television     setan hour a day, on average. When they do watch, they typically favor     news and sports over most prime-time fare.

Classical music is the clear favorite of physicians, cited by 42 percent     of our respondents.

fantasies are fairly subdued. Asked what they'd do     with a sudden windfall of $100,000, only a small minority mentioned jetting     off to some exotic locale. Most would pay off their debts or set up savings     accounts for their children and grandchildren. For every doctor who'd blow     the cash on a new Mercedes, there were a couple who'd give it to a women's     shelter, their church, local hospital, or alma mater.

Asked what they would do with an extra two hours a day, most physicians     said sleep or spend more time with their families. Many would devote the time     to charities or community service activities. 

Does any of this sound like you? Or are you among the more unorthodox doctors who say that New Age music is their favorite, or that the soap opera 

 Whether you're "typical" or not, we're sure you'll find plenty to identify   with in our articles about what your colleagues think about marriage, parenting,   politics, religion and charity, vice, guns, and leisure activities. The final   result is a most revealing self-portrait of physicians' personal lives.

 

Mark Crane. A special issue on doctors' lifestyles. 

Our comprehensive national survey explores the ways physicians live and think when they&re not at work.

A special issue on doctors' lifestyles

 NPs and PAs: What's the malpractice risk? 

 When properly supervised, physician assistants   and nurse practitioners should reduce your malpractice risk. "Properly supervised"ah,   there's the rub. 

 Will hiring a physician assistant or nurse practitioner increase   or decrease your risk of being sued for malpractice? 

 Judging from the actual number of malpractice cases settled,   PAs and NPs are in court much less often than their doctor colleagues. But before   you launch a recruitment effort, bear in mind that there are many more PAs and   NPs practicing today than just a few years ago, and lawsuits take a while to   reach the courts. In theory, however, both the AMA and allied health organizations   agree that properly supervised PAs and NPs should lower a physician's liability   risk. 

 Why? "Most lawsuits are filed because of a lack of communication,   a lack of basic follow-up," says Judith A. Berman, an attorney and RN in Phoenix.   "Midlevel providers are trained to do a better job taking histories and establishing   rapport. When they're employed correctly, there's less of a chance for things   to fall through the cracks." They also increase patient satisfaction by reducing   office waiting time and devoting more attention to patientsand a satisfied   patient is less likely to sue. As an added bonus, these providers allow the   supervising physician time to concentrate on more complicated cases. 

 Other experts, though, warn physicians against allowing too much   autonomy. "In the past three years, I've filed five cases against physicians   because of faulty performance by a midlevel provider," says Evelyn W. Bradford,   a plaintiffs' attorney in Waynesboro, PA. "In each case, the provider made significant   decisions on his own without consulting the doctor, who often didn't even know   of a problem until the summons was served." 

 Professional liability insurers caution that claims could increase   as more practices employ PAs and NPs. "The number of suits isn't disproportionate   yet, but we're seeing an occasional instance of midlevel providers practicing   beyond their level of expertise," says Richert E. Quinn, a general surgeon and   vice president of risk management for Copic Insurance Co., a Colorado-based   malpractice carrier. "We're seeing more adverse outcomesespecially delayed   or missed diagnoses of cancer and heart attacks, and prescribing errors. 

 "A PA or NP may watch a palpable breast lump for months without   alerting the doctor, and it could turn out to be cancerous," says Quinn. "One   PA missed a diagnosis of flesh-eating bacteria. The danger occurs when providers   don't recognize when they are practicing beyond their training. Even with appropriate   supervision, mistakes will still occur, but they can be minimized. The provider   has to know his limitations and when to ask for help." 

 Consider these recent lawsuits, attributable to haphazard supervision   by doctors: 

  A 2-year-old boy with a high fever and upper respiratory   infection was seen by a PA. X-rays confirmed the PA's diagnosis of pneumonia   in both lungs. The boy's parents wanted him hospitalized, but instead the PA   prescribed antibiotics and sent the family home. The next morning, the boy went   into acute respiratory failure and died before he could be brought to the hospital. 

 "The experts I consulted felt he should have been hospitalized   right away and started on IV antibiotics," says Evelyn Bradford, who represents   the child's parents. "Nurses at the hospital could have spotted the earliest   signs of respiratory distress. Sending the child home deprived him of his only   chance. The doctor employer was completely out of the loop; the PA never contacted   him." And the doctor evidently didn't check on what his PA was doing. The case   was settled for an undisclosed amount. 

  In a Wisconsin case, physicians discovered a heart murmur   during a routine physical on a 45-year-old man. An ECG revealed a bicuspid aortic   valve and mild to moderate regurgitation. No one warned the patient that, because   of the increased risk of infection, he should be given prophylactic antibiotics   prior to dental procedures. Shortly after a root canal, the patient developed   flu-like symptoms. He was seen by a PA, who noted his cardiac and dental history   in the chart. The patient's health deteriorated over the next two months, but   the doctorwho later said his custom was to review only the patient's chief   complaint and the PA's recommendationsdidn't read the chart carefully   enough. He should have seen that the patient was at risk for bacterial endocarditis.   A wrongful-death suit was settled for $1.2 million. 

 In each case, the supervising physician was sued along with the   PA. "The physician is liable for reviewing all pertinent information when authorizing   an NP or PA's treatment plan," says Lee J. Johnson, an attorney in Mount Kisco,   NY. "You may delegate the history-taking to one of these providers, but you   haven't delegated the liability." 

 Creating a composite of several cases she's seen, attorney Judith   Berman illustrates how easily disastrous missteps can occur. "While you're on   vacation, the NP or PA sees a longtime patient for URI symptoms that could be   viral or bacterial. The patient insists on an antibiotic. The midlevel provider   is unable to find the chart because the patient was worked into the schedule   at the last minute. She asks the patient about allergies, documents NKDA, but   doesn't get a full medication history. She writes a prescription for trimethoprim-sulfamethoxazole,   and your partner signs off on the chart on his way out the door to the ER. The   patientwho, it turns out, is allergic to sulfa drugsdies four days later   of pseudomembranous colitis. You, your partner, your corporation, and the NP/PA   are hit with a wrongful-death suit." 

 In nearly every malpractice lawsuit involving an NP or PA, the   physician, hospital, health plan, or clinic that employs the provider will also   be named as a defendant, says Nancy Hughes, vice president of communications   for the American Academy of Physician Assistants. "It's rare to see a lawsuit   where the NP or PA is the only or even the prime defendant. Plaintiffs typically   allege that the physician is liable for providing inadequate supervision." 

 The scope of each profession's practice is dictated by state   law, and the variance can be significant. Every state but Mississippi requires   that doctors supervise PAs, and many states require NPs to work in collaborative   relationships with doctors. Some states mandate that NPs follow detailed clinical   protocols, and there may be rules regarding physician accessibility, chart reviews,   and conferencing. States also might regulate the number of PAs a physician can   supervise. 

 If you're thinking about adding an NP or PA to your practice,   ask your state medical board about diagnosing and prescribing rules, and the   amount of supervision needed. AAPA (

)   publishes a summary of state laws governing PAs. Similarly, the Web site of   the American Academy of Nurse Practitioners (

)   has a chart depicting prescriptive authority for NPs. 

 If the NP or PA is your employee, you're responsible for her   acts within the regular scope of her job under the legal doctrine of respondeat   superior, says attorney Lee Johnson. You could also be held vicariously liable   under the "borrowed servant" doctrine for providers who work for you as independent   contractors. That might occur if the patient reasonably believes that the PA   or NP is acting as your agent or employee. 

 NPs typically have a formal collaborative arrangement with physicians.   As such, the physician commits to a certain level of supervision, which usually   requires at least periodic review of records and ongoing consultation. A doctor   could be considered liable if he reviews a patient's case but fails to make   medically reasonable recommendations, says Johnson. 

 Occasionally, an NP or PA might be found liable while her supervising   physician is exonerated. That occurred recently in a case involving a rural   health clinic in the South. Both the NP and physician were employees of the   hospital that owned the clinic, says Karen Everitt, risk management consultant   for Medical Assurance, a malpractice insurer based in Alabama. A young woman   presented with abdominal cramping, nausea, and vomiting. An NP diagnosed gastroenteritis   and instructed the patient to seek follow-up care if the symptoms recurred or   worsened. No lab work was performed. The patient was never seen by the supervising   physician, but he signed off on the patient's chart when he reviewed it that   day. 

 Two days later, the patient died. An autopsy revealed peritonitis   secondary to a ruptured appendix. The family sued the clinic, physician, and   NP. They alleged negligent supervision by the doctor and said that he should   have personally examined the patient. The jury found the clinic and NP liable   and awarded $1 million, but it cleared the doctor. "Apparently the jury felt   it wasn't an issue of supervision, but more of an NP's using poor judgment in   not seeking the collaborating doctor's help," says Everitt. 

 Be sure to check the credentials of the provider you're considering   hiring. Call the relevant state licensing board or professional association,   and verify that the applicant graduated from an accredited program. "Both physicians   and malpractice insurers can do a better job on this," says Richert Quinn. "We   may see an increase in lawsuits against physicians for hiring midlevel providers   without the proper credentials." 

 The biggest malpractice risks occur when PAs or NPs practice   beyond their level of training and wait too long to contact the physician. "Remember,   these providers are supposed to extend, and not replace, a physician's services,"   says Quinn. 

 "The entire relationship between the doctor and other health   providers should be clearly spelled out with a written job description and practice   protocols that indicate the type of patients to be seen and the level of treatment   to be provided," advises Judith Berman. "Tell the PA or NP how you see her role.   Define what conditions and complaints are appropriate for first-level care,   and when she must send the patient back to you or a specialist. A provider who   doesn't know her limits, or fails to provide care within those limits, is no   asset to your practice." 

 The tendency, however, has been for states to broaden the scope   of NP and PA authoritya development that makes some doctors nervous. Recently,   doctors in Michigan staged an unsuccessful attempt to halt implementation of   a new rule that allows PAs and NPs to prescribe Schedule II controlled drugs. 

 "Direct liability could be imposed upon the physician for delegating   the prescribing of controlled substances when the physician either knew or should   have known that the midlevel provider wasn't properly trained to prescribe such   drugs," says Richard D. Weber, the society's legal counsel. Any claim asserted   by a patient arising out of the prescribing of a controlled substance will almost   certainly be filed against the delegating physician, he adds. "We're not anti-PA   or anti-nursing, and we're not opposed to a provider dispensing routine medications   at the instruction of the doctor," says Weber. "But prescribing controlled substances   is riskier." 

 The society was especially concerned because Michigan doesn't   require a physician to be at the same site as the PA or NP on a regular basis.   "The definition of supervision is extremely broad," Weber says. "Technically,   a doctor could be said to be supervising while he's vacationing on the beach   in Hawaii. That clearly isn't acceptable." 

 Don't penalize a provider for seeking help 

 The most self-defeating thing a doctor can do is create an atmosphere   where the NP or PA is afraid to pose questions or ask for assistance, says Richert   Quinn. "In most practices we see, these people are employed wisely with appropriate   supervision. But we know of situations where they are essentially on their own.   The doctors don't realize that they're exposing 

 One PA who practices in the Northeast tells this cautionary tale.   "My first job after finishing my training was in a hospital emergency room,"   says the PA, who asked not to be identified. "I basically didn't know how to   swim yet, but they threw me into the deep end of the pool and told me I was   the lifeguard. The doctors, who also were under tremendous pressure, bitterly   complained when I asked questions or wanted them to examine patients. It was   terrifying. If I kept asking for help, I was afraid I'd be fired. When I didn't   seek help, I was afraid of injuring a patient or missing some serious problem.   I quit that job as soon as I could." 

 The situation wasn't helped by the fact that patients often assumed   the PA was a physician. "They kept saying, 'Okay, Doc.' I'd correct them, often   to no avail." That confusionand feeling trickedcan lead a patient to a plaintiffs'   attorney. "Doctors need to educate patients about the PA's role," says Evelyn   Bradford. "When the receptionist says, 'The doctor is all booked up, but the   physician assistant can see you at 2 pm,' it should be made clear that the assistant   isn't a doctor." 

 Some invasive procedures by NPs and PAs require formal informed   consent documenting who is performing the procedure. "This isn't being done   as rigorously as it should be," notes James Lewis Griffith Sr., a malpractice   attorney in Philadelphia. "If something goes wrong, the patient is likely to   argue, 'I never would have consented to this if I'd known a nonphysician was   doing it.' This could be an area of increased risk for physicians." 

 AAPA's Nancy Hughes says many states mandate that PAs identify   themselves as such. Some jurisdictions even require name tags to drive the point   home. 

 Who provides malpractice insurance for PAs and NPs? 

 Since physicians are primarily liable for the actions of their   employees, they must notify their malpractice carrier when they hire a certified   health professional. "The premium is fairly nominal," says Copic's Richert Quinn.   "We might add an extra $1,000 to the doctor's malpractice premium if the PA   or NP assists during surgery or works for a doctor in a high-risk specialty.   But this is a shared limit. So if the doctor is insured for $1 million per incident/$3   million aggregate, the same policy limits apply." 

 But many PAs and NPs insist on having an individual malpractice   policy. Such a policy entitles them to their own defense attorney and protects   them if they change jobs or the employing physician closes his practice before   a malpractice claim is filed. It also reimburses these clinicians for time away   from work to give depositions, pays for legal fees to defend a professional   license before a state agency, and offers access to the insurer's experienced   risk-management consultants. 

 AAPA offers a $100,000/$300,000 policy through its own liability   program for PAs who work in primary care. The cost is generally less than $600   a year; rates and coverage limits are higher for PAs working in high-risk areas   such as obstetrics, surgery, and cardiac catheterization labs. Some physicians   offer to purchase the provider's policy as a recruiting incentive. No matter   who pays for the policy, though, the physician's liability remains the same,   notes Quinn. 

 Whether a PA or NP is a major assetor a major liabilityto   a practice ultimately depends on the supervising physician. "If you're just   looking to increase your income by hiring a PA or NP and you don't want to spend   time working with her, that's very ill-advised," says family physician Dewayne   P. Darby, who has two physician assistants in his four-doctor Jefferson City,   TN, practice. "Besides the liability risk, your patients won't be happy with   that kind of relationship, either." 



Mark Crane. NPs and PAs: What's the malpractice risk?. 

When properly supervised, physician assistants and nurse practitioners should reduce your malpractice risk. "Properly supervised"--ah, there's the rub.

NPs and PAs: What's the malpractice risk?

Charges vs reimbursements: The gap widens again

Physicians are holding the line on fee increases, but thirdparties are paying less than before, our latest survey shows.

The disparity between fees and reimbursements keeps growing, no matterwhat doctors do. That's the conclusion of the latest 

Continuing Survey, which samples MDs and DOs in office-based private practice.

For the third straight year ­ we began studying reimbursements onlyfour years ago ­ physicians got paid less for major procedures and services.This time, payments fell an average of 3 percent. In the previous two years,they dipped almost 4 percent and more than 5 percent, respectively.

Reimbursements fell for 46 of the major procedures and services we analyzed,went up for 16, and stayed the same for five. Some of the cuts were tiny,while others were dramatic. For example, both internists and cardiologistsreported a drop of $2 in what they're paid for ECGs. Cardiothoracic surgeons'median reimbursement for ascending aorta graft with cardiopulmonary bypass,on the other hand, dropped by a staggering $846, or 27 percent, to $2,298.

For their part, doctors kept price hikes modest. Median fees rose justunder 3 percent overall. Forty-five services or procedures saw fee hikesthat averaged 6 percent, 18 saw declines that averaged 5 percent, and 5saw no change.

Physicians did make some headway last year on reimbursement for officevisits, but the gain was small. Median fees for new-patient visits to doctorsin all fields of practice combined rose in four of the five CPT codes byan average of $2.80. However, reimbursements increased by only $1, on average.For subsequent office visits, fees increased an average of $2, while reimbursementsrose by $1.

Family physicians raised their median initial office-visit fees in allfive codes by an average of $5.20. The biggest jump was for code 99205,which went up by $12. FP's actual payments, however, increased by only $3on average for the five codes. While FPs increased their charges for hospitalcare by an average of $8, reimbursement rose by less than $4. Despite a$20 increase in the fee for flexible sigmoidoscopy, reimbursement fell by$3.

Internists also raised median initial office-visit fees in all five codes,by an average of $3.80. Reimbursement was up in only two codes, however,by an average of $1.40. These physicians raised the median fee for sigmoidoscopyby $43, but reimbursement rose by only $5.

GPs' initial office-visit fees and reimbursements increased by an averageof $9. For revisits, fee hikes averaged $8, while reimbursement increasedby $4.

Gastroenterologists raised median initial office fees by an average of$7, while payments rose by $3. For hospital care, median fees increasedan average of $4, while actual pay rose only $1. Fees for flexible sigmoidoscopyand upper-GI endoscopy were unchanged. Median fees for liver biopsy anddilation of esophagus increased by 2 and 10 percent, respectively. Overall,reimbursement for the procedures we asked about rose by 4 percent.

Cardiologists raised median initial office fees by an average of $8,while payments rose by $2. For revisits, both fees and reimbursement roseby $1. For major procedures, fees rose by a scant 1 percent. Reimbursementdipped by 8 percent on average, excluding a 53 percent hike for injectionfor selective left ventricular angiography.

Pediatricians raised median office visit fees by an average of $2, whilereimbursement dipped by $1. For hospital visits, fees increased by an averageof $6, while reimbursement rose $2. Median fees for the four services weanalyzed rose by about 5 percent, but reimbursement dropped about 2 percent.

Ob/gyns raised office visit fees by an average of $1.30, while reimbursementswere virtually unchanged. These specialists raised fees for seven procedures,lowered them for one, and left them unchanged for one. On average, feeswere up 3 percent. Reimbursement dipped by 2 percent, including a 21 percentcut for colposcopy.

General surgeons raised office fees by an average of $3.60, while paymentsincreased by $2. Fees for major procedures were virtually unchanged, butreimbursement dipped by an average of 4 percent, including a $147 cut forlaparoscopic cholecystectomy.

Orthopedic surgeons' office fees dipped 2 percent overall, but the chargefor code 99215 dropped $11. Reimbursement was down an average of $1. Feeincreases for major procedures averaged 3 percent. Reimbursement droppedin seven of eight procedures, by an average of 6 percent. These specialistsraised the median fee for lumbar arthrodesis by $557, or about 15 percent.That didn't stop reimbursement from shrinking by 10 percent, or $227. Soorthopedists receive only 44 percent of that posted fee.

Plastic surgeons' office fees rose by an average of $2, while reimbursementfell by the same amount. But when it comes to procedures, both fees andactual payments increased by the same amount ­ an average of 5 percent.Still, these specialists lost ground on individual procedures. Althoughthe typical plastic surgeon charges $427 more than last year for performinga bilateral breast augmentation, he receives the same payment as in 1998.

Cardiothoracic surgeons lowered median fees for seven of the 10 procedureswe analyzed by an average of 1 percent. Reimbursements fell much further,though, by an average of 11 percent. That drop includes a 27 percent cutfor ascending aorta graft with cardiopulmonary bypass and a 24 percent paycut for lobectomy.

Neurosurgeons' fees for major procedures increased by 2 percent on average,but reimbursements fell by 10 percent.

How do your fees and reimbursement levels stack up against the normsset by colleagues in your specialty, size of practice, and region? See theaccompanying charts, tables, and commentaries. For a description of howthe survey was conducted, see the 

This article is copyright 1999 by Medical Economics at Montvale, NJ07645. All rights reserved. It may not be reproduced, quoted, or paraphrasedin whole or in part in any manner whatsoever without the prior written permissionof the copyright owner.

What doctors in 12 fields charge for office visits

In a virtual reprise of last year, median fees for initial visits increasedin four of five CPT codes, by an average of $2.80. But physicians actuallyreceived only $1 of that amount. Nonsurgeons raised median fees in all fivecodes, including an $8 increase for 99204. They received only $1 more, though.For established patients, fees rose by an average of $2, while reimbursementswere virtually unchanged.

*Insufficient sample. Unless otherwise specified, all fee tabulationsin this article are medians drawn from the 

 ContinuingSurvey. Where no year is given, figures are for the spring of 1999.

Last year, reimbursement for injection for selective left ventricularangiography dropped by a staggering 40 percent. This year, cardiologistsraised their median fee for the procedure by $31, and reimbursement increasedby 53 percent, or $26. The typical fee for echocardiography (93307) increasedby 2 percent, while reimbursement dipped 4 percent. Fees for left heartcatheterization (93510) and echocardiography (93350) each decreased by 6percent, but reimbursement fell even further by 16 percent and 15 percent,respectively.



Carol Pincus, ed. Mark Crane. Charges vs reimbursements: The gap widens again. 

Physicians are holding the line on fee increases, but third parties are paying less than before, our latest survey shows.

Author | Mark Crane

Articles

Doctors say, and do, the darndest things

A special issue on doctors' lifestyles

NPs and PAs: What's the malpractice risk?

Charges vs reimbursements: The gap widens again