Banner

News

Article

Exclusive survey: Fees & reimbursements

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

 
99201
99202
99203
99204
99205
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Cardiologists
$65
$35
$100
$63
$124
$89
$180
$121
$225
$154
FPs
56
35
80
58
105
80
150
110
185
139
Gastroenterologists
65
40
91
59
125
80
165
105
200
140
GPs
50
40
73
55
90
70
130
100
160
120
Internists
56
40
80
60
105
80
150
100
200
130
Ob/gyns
63
47
89
65
120
80
159
100
200
125
Pediatricians
57
40
83
58
103
78
145
96
180
130
All primary care
56
40
80
60
109
80
150
100
194
130
 
99211
99212
99213
99214
99215
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Cardiologists
$35
$21
$55
$34
$75
$49
$100
$73
$150
$100
FPs
32
20
50
35
65
48
97
73
136
106
Gastroenterologists
35
20
50
32
70
45
90
65
130
88
GPs
30
22
45
35
60
47
85
70
120
99
Internists
35
20
50
35
66
49
98
70
138
100
Ob/gyns
35
25
60
40
75
55
105
75
150
100
Pediatricians
35
20
50
35
65
48
95
69
125
84
All primary care
35
21
50
35
68
49
99
70
137
100

 

Fees are affected by . . .

 
New patient (99204)
Established patient (99213)
Fee
Actual payment
Fee
Actual payment
1-5
$150
$110
$68
$45
6-10
154
101
73
50
11-20
150
100
68
49
21-30
155
109
67
48
30+
150
120
65
49
East
$150
$100
$70
$48
South
150
105
68
48
Midwest
150
108
65
49
West
162
110
72
51
30-34
$150
—*
$65
—*
35-39
160
$90
75
$46
40-44
150
100
68
50
45-49
150
110
67
50
50-54
160
110
70
48
55-59
140
100
65
48
60-64
150
110
65
49
65-69
150
—*
65
—*
Male
$150
$100
$68
$49
Female
150
110
70
48

 

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

 
Internists
FPs
Gastroenterologists
$275 or more
7%
11%
21%
$250-274
8
16
12
$225-249
15
6
6
$200-224
15
16
18
$175-199
15
15
13
$150-174
10
19
18
$125-149
10
9
4
$100-124
15
<1
5
Less than $100
5
8
3
Median fee
$189
$195
$200
Median reimbursement
—*
—*
90

 

How cardiologists are doing

Median fee
$450
Median reimbursement
200
Median fee
$500
Median reimbursement
250
Median fee
$650
Median reimbursement
250
Median fee
$250
Median reimbursement
55
Median fee
$200
Median reimbursement
—*

 

Typical charges and reimbursements
in four specialties

 
Fee
Actual payment
Dilation of esophagus, by unguided sound or bougie, single or multiple passes (43450*)
$225
$100
Liver biopsy, needle; percutaneous (47000*)
330
125
Upper GI endoscopy, diagnostic (43235)
500
200
Circumcision, clamp, newborn (54150)
$250
$120
Colposcopy (vaginoscopy); LEEP (57460)
600
250
Complete OB care, routine, vaginal delivery (59400)
2,500
1,800
Complete OB care, routine, w/cesarean section (59510)
3,000
2,000
Dilation & curettage, diagnostic and/or therapeutic (non-ob) (58120)
660
300
Laparoscopy, surgical, with fulguration of oviducts (58670)
1,420
600
Total hysterectomy, abdominal (58150)
2,700
1,100
History & examination of normal newborn (99431)
$140
$86
Immunization, DTaP (90700)
35
25
MMR virus vaccine, live (90707)
52
40
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?

 
99221
99222
99223
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
FPs
$125
$76
$157
$102
$200
$138
Gastroenterologists
120
66
158
100
200
135
Internists
100
75
150
100
195
135
 
99231
99232
99233
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
FPs
$65
$35
$80
$53
$120
$74
Gastroenterologists
60
35
80
50
110
70
Internists
60
40
80
55
105
75
Pediatricians
60
42
80
60
115
75

 



Dorothy Pennachio. Exclusive survey: Fees & reimbursements.

Medical Economics

Oct. 10, 2003;80:96.

Related Videos