Fee Survey

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 Medical EconomicsContinuing 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 Sept.20, 1999, issue.

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

The range of fees for cardiologists

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.

By Mark Crane, Senior Editor

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

Medical Economics

1999;19:180.