Exclusive survey: Fees & reimbursements

October 10, 2003

Doctors continue to raise fees in hopes of recouping increased practice expenses, but reimbursements are thwarting the plan, according to our latest Continuing Survey.

COVER STORY

Exclusive survey
Fees & reimbursements

Jump to:Choose article section...What your colleagues charge for office visits Fees are affected by . . . What IMs, FPs, and GIs charge for flexible sigmoidoscopies (45330) How cardiologists are doing Typical charges and reimbursements in four specialties What about hospital care?

Doctors continue to raise fees in hopes of recouping increased practice expenses, but reimbursements are thwarting the plan, according to our latest Continuing Survey.

By Dorothy L. Pennachio
Senior Editor

 

Reimbursements for primary care physicians are not keeping pace with moderate increases in fees. If that sounds familiar, it should. It's been the reality physicians have faced for the past several years.

According to the Medical Economics Continuing Survey, which samples MDs and DOs in office-based private practice, primary care physicians raised their median office visit fees this year by an average of 4.9 percent in the 10 CPT codes we surveyed. However, reimbursements were virtually unchanged—up just 0.5 percent—over 2002.

Office visit fees for FPs rose an average of 6.3 percent, while reimbursements inched up only 0.7 percent. The picture was worse for hospital care: FPs' median fees for six hospital care codes rose by an average of 7.3 percent, while reimbursements decreased by nearly 4 percent.

Internists fared even worse. They increased median fees for new and established patient visits by 1.5 percent, while reimbursements declined by 2 percent. Internists fared better in the hospital. Although their fees were virtually unchanged, they saw substantial increases in reimbursement for two codes—a 15 percent jump for initial hospital care (99221), and a 14 percent jump for subsequent hospital care (99231). Internists raised their median fee for flexible sigmoidoscopy by 2 percent and for ECG with interpretation and report (93000) by 7 percent.

GPs' did best of all primary care physicians in the fee/reimbursement battle: Median office visit fees rose by an average of 2.1 percent, while reimbursement climbed 5.7 percent, including a 15 percent hike for 99214 and a 14 percent increase for 99215.

While cardiologists' median office fees rose by 4.5 percent, the story was different for their most commonly performed services and procedures. Fees for four of the five services we surveyed decreased by an average of 5.2 percent, yet reimbursements rose.

Gastroenterologists saw fees and reimbursements take nearly an equal, but opposite, tack: Median fees for initial office visits rose an average of 3.8 percent, while reimbursement decreased by 3.6 percent. The picture was even bleaker when it came to revisits. Fees dropped 1.4 percent and median reimbursement dropped in all five codes by an average of 7.6 percent. Payment for all six hospital care codes dropped by an average of 7.1 percent and for liver biopsy by 9 percent.

Pediatricians' median office visit fees rose an average of 5.7 percent, while reimbursement climbed by 1.3 percent. These specialists actually lowered median fees for subsequent hospital care by an average of 8.3 percent, while reimbursement declined by 4.3 percent. Median fees for history and examination of a normal newborn dropped by 7 percent, while reimbursement declined 11 percent.

Ob/gyns lucked out. Even though they held fees steady for 99211, their reimbursement rose by 19 percent. These doctors raised their median fees for 99212 from $51 to $60, and reimbursements went up from $35 to $40. Ob/gyns raised the median fee for circumcisions by 25 percent, while reimbursements went up only 9 percent. They didn't gain much ground overall, though: fees for their major procedures increased by 4.7 percent, but reimbursements rose by just 3.9 percent.

Is there anything doctors can do about shrinking reimbursements? Consider joining a larger group. "These typically have more clout with the plans than smaller practices," says Barry Pillow of HealthCare Consulting in Greensboro, NC. Multispecialty groups also report charging more for new and established patient visits than do small or single-specialty ones.

Or consider moving. As it was 10 years ago, fees charged by doctors in the West are higher than in other areas—$162 for a new patient visit and $72 for an established patient. In 1993, western FPs charged $95 for 99204 and $45 for 99213.

Pillow also recommends a regular fee analysis. "Look at your contracts and see what payers are reimbursing for various codes," he says. "Then set your fees to maximize reimbursement."

The alternative—to blindly increase fees across the board—just means that you're likely to increase your writeoffs. "We'd like to increase fees across the board by 5 percent, but it's a no-brainer that raising fees doesn't mean raising reimbursements," says Charles Davant III, an FP in Blowing Rock, NC. "Only the uninsured fall outside, and for the most part, they don't pay anyway. So we're stuck."

A large percentage of Davant's practice is Medicare, and for those patients, estimates are that CMS will likely reduce payments to physicians next year by 4.2 percent. "Several of the large insurance companies base their reimbursement on 115% of what Medicare pays," he says. "We can't continue this way."

In an effort to offset steadily dropping reimbursements, many doctors are beginning to charge for services that used to be gratis—like phone calls, filling out forms, and copying records.

Next year, our Continuing Survey will include a few questions about these charges. Meanwhile, here are some representative fees we've heard about from talking with doctors and consultants:

• Transferring records: $10

• Calling pharmacies with script refills: $5

• Filling out forms for school and camp physicals or disability insurance: $15-25 or 25 cents per page

• Resolving complex insurance problems: $100 an hour

• Making after-hours telephone calls: $2 per minute; $25 if the problem could have been dealt with during office hours

• Consulting with family: $15 to $50

When considering whether to charge for these services, consult with your payers: The charges might violate your contracts and cause you to be dropped from networks.

How do your fees and reimbursements compare to those of your colleagues? The charts and tables on the below will give you an idea. For a description of how the survey was conducted, see "Physicians' earnings: Our exclusive survey" from our Sept. 19 issue.

 

What your colleagues charge for office visits

 9920199202992039920499205
FeeActual paymentFeeActual paymentFeeActual paymentFeeActual paymentFeeActual payment
Cardiologists$65$35$100$63$124$89$180$121$225$154
FPs5635805810580150110185139
Gastroenterologists6540915912580165105200140
GPs504073559070130100160120
Internists5640806010580150100200130
Ob/gyns6347896512080159100200125
Pediatricians574083581037814596180130
All primary care5640806010980150100194130
 9921199212992139921499215
FeeActual paymentFeeActual paymentFeeActual paymentFeeActual paymentFeeActual payment
Cardiologists$35$21$55$34$75$49$100$73$150$100
FPs3220503565489773136106
Gastroenterologists352050327045906513088
GPs302245356047857012099
Internists3520503566499870138100
Ob/gyns35256040755510575150100
Pediatricians352050356548956912584
All primary care3521503568499970137100

 

Fees are affected by . . .

 New patient (99204)Established patient (99213)
FeeActual paymentFeeActual payment
1-5$150$110$68$45
6-101541017350
11-201501006849
21-301551096748
30+1501206549
East$150$100$70$48
South1501056848
Midwest1501086549
West1621107251
30-34$150—*$65—*
35-39160$9075$46
40-441501006850
45-491501106750
50-541601107048
55-591401006548
60-641501106549
65-69150—*65—*
Male$150$100$68$49
Female1501107048

 

What IMs, FPs, and GIs charge for
flexible sigmoidoscopies (45330)

 InternistsFPsGastroenterologists
$275 or more7%11%21%
$250-27481612
$225-2491566
$200-224151618
$175-199151513
$150-174101918
$125-1491094
$100-12415<15
Less than $100583
Median fee$189$195$200
Median reimbursement—*—*90

 

How cardiologists are doing

Median fee$450
Median reimbursement200
Median fee$500
Median reimbursement250
Median fee$650
Median reimbursement250
Median fee$250
Median reimbursement55
Median fee$200
Median reimbursement—*

 

Typical charges and reimbursements
in four specialties

 FeeActual payment
Dilation of esophagus, by unguided sound or bougie, single or multiple passes (43450*)$225$100
Liver biopsy, needle; percutaneous (47000*)330125
Upper GI endoscopy, diagnostic (43235)500200
Circumcision, clamp, newborn (54150)$250$120
Colposcopy (vaginoscopy); LEEP (57460)600250
Complete OB care, routine, vaginal delivery (59400)2,5001,800
Complete OB care, routine, w/cesarean section (59510)3,0002,000
Dilation & curettage, diagnostic and/or therapeutic (non-ob) (58120)660300
Laparoscopy, surgical, with fulguration of oviducts (58670)1,420600
Total hysterectomy, abdominal (58150)2,7001,100
History & examination of normal newborn (99431)$140$86
Immunization, DTaP (90700)3525
MMR virus vaccine, live (90707)5240
Appendectomy (44950)$1,380—*
Cholecystectomy (47600)1,950—*
Excision of cyst or fibroadenoma from breast tissue, one or more lesions (19120)800—*
Initial inguinal hernia repair, age 5 or over; reducible (49505)1,200—*
Laparoscopy, surgical; cholecystectomy (47562)2,200—*
Modified radical mastectomy (19240)2,373—*

 

What about hospital care?

 992219922299223
FeeActual paymentFeeActual paymentFeeActual payment
FPs$125$76$157$102$200$138
Gastroenterologists12066158100200135
Internists10075150100195135
 992319923299233
FeeActual paymentFeeActual paymentFeeActual payment
FPs$65$35$80$53$120$74
Gastroenterologists6035805011070
Internists6040805510575
Pediatricians6042806011575

 



Dorothy Pennachio. Exclusive survey: Fees & reimbursements.

Medical Economics

Oct. 10, 2003;80:96.