• Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

New Fee Survey: Bridging the reimbursement gap

Article

Our latest survey on fees and reimbursements shows a continuing--and substantial--gap between what you charge and what you get paid.

 

Cover Story

NEW FEE SURVEY

Bridging the reimbursement gap

Jump to:
Choose article section...How practice size affects feesWhat doctors in 10 fields charge for office visitsFees are also affected by . . . Internists lose ground; FPs gain Typical charges and reimbursements in five specialties Physicians receive no extra reimbursement for hospital care

Our latest survey on fees and reimbursements shows a continuing—and substantial— gap between what you charge and what you get paid.

By Wayne J. Guglielmo
Senior Editor

Where do you think reimbursements are heading?

The formula might as well be set in stone: Once again this year, as for the past several years, primary care physicians report getting paid about 75 percent of their charges for office visits. Physicians overall get paid less than 50 percent for most major CPT procedures and services, according to the results of the latest Medical Economics Continuing Survey of MDs and DOs in office-based private practice.

Overall, primary care physicians raised median office visit fees in all 10 CPT codes by an average of 7.5 percent, or $6.80. Although reimbursements nearly matched the percentage increase at 7.3 percent, that $5.60 wasn't nearly enough to close the fee-reimbursement gap.

GPs were the most aggressive of the primary care group, raising their median office-visit fees an average of $11.10 per visit. But their reimbursements went up by only $8.10.

General internists, who posted the lowest dollar increase among primary care physicians, raised their office visit fees by an average of just $4.70, and actually dropped their fees for CPT codes 99201 and 99211, level 1 visits for new and established patients. Reimbursements increased $6.50 on average.

The picture for procedures was a mixed bag for internists. Median fees for sigmoidoscopies rose by $11, or 6 percent, while reimbursements remained flat at $100. Internists saw both their median fee and reimbursement for ECGs drop, by 8 percent and 6 percent, respectively.

Family physicians are narrowing the gap between themselves and general internists in office visit charges. This year, FPs raised median office-visit fees by $7.10 on average, with the biggest increases in codes 99204 (up $19) and 99205 (up $18). With these increases, fees for FP office visits are now only $5.50 less on average than internists' charges.

As for procedures, FPs get even more than internists for at least one common office procedure—sigmoidoscopy. This year, they raised their median fee to $200, a 20 percent increase over 2001. In return, they receive $110—$10 more than the typical internist and gastroenterologist get paid.

It was a mixed bag for cardiologists this year, too. On the one hand, the median fee increases they took in six out of 10 office-visit codes were almost entirely matched in reimbursement increases. On the other hand, their average fee increase of $25 for the five procedures we tracked was offset by a $15.20 loss in reimbursements. Despite a $100 increase in the median fee for left-heart catheterization, for example, they actually got back $41 less from insurers.

Gastroenterologists did better in 2002 on office visits. They raised their fees an average of $3.30, but saw a robust increase in reimbursements of $4.70. For CPT codes 99203 and 99205, fees remained flat, but reimbursements were up $4 and $10, respectively. Reimbursements also increased by $10 for sigmoidoscopies.

The news wasn't as good on several other procedures, though. The median fees for upper GI endoscopy increased by $25, but actual payment fell $20. Similarly, gastroenterologists raised their fees for liver biopsy by $12, but their reimbursements dipped by the same amount. Both fees and reimbursement for dilation of the esophagus remained unchanged.

Pediatricians had bad news and good. They raised median office fees by $7, but saw only $4.70 of that returned. There was no substantial increase in reimbursements for hospital visits. Pediatricians did slightly better on most procedures, and especially well on circumcisions. Their circumcision fees rose 20 percent, while reimbursement rose a healthy 45 percent.

Ob/gyns, on the other hand, kept their median fee for circumcision the same, while reimbursement rose 10 percent. Ob/gyns now receive $35 less than pediatricians for the same procedure.

Ob/gyns did see a $5 return on their fee increase of $4.70 for office visits, though. For the eight procedures for which we have comparable data, they saw almost no change at all (–0.4 percent) in reimbursements over last year.

Median office-visit fees for general surgeons also remained virtually flat this year, while their reimbursements rose by an average 8.8 percent. For the eight procedural codes for which we have comparable data, the average fee increase was 6.3 percent, while reimbursements went up 8.5 percent.

The picture was less bright for orthopedic surgeons. Their office-visit fees were up $2.90 or 5.4 percent, but reimbursements decreased by 89 cents. For the seven procedural codes we tracked, they gained about 4 percent on the fee side and about 2 percent on the payment side.

How can doctors cope in this precarious economic environment?

"Since managed care payments can vary by more than 20 percent per plan, well run practices have begun reviewing what each plan pays and deselecting those that don't make the grade," says Michael Wiley, a practice-management consultant from Bay Shore, NY. Wiley also recommends that doctors increase their fees, "avoiding the chance they're charging less than an insurance company would have paid," he explains.

That was the strategy used by internist Scott P. Rigby, of Munroe Falls, OH, when he discovered his nine-member group was missing out on a quarter of a million dollars because of a poorly calibrated fee structure. Says Rigby: "Calculating maximum reimbursement, I realized, was the key to increasing our revenue—without requiring any of the partners to see more patients, work longer hours, or take less vacation. Basically, this was lost money waiting to be found. And I found it." (See "We're not leaving $250,000 on the table anymore," Sept. 9, 2002. )

How do your fees and reimbursements compare to those of your colleagues in the same specialty, region, and practice size? The accompanying tables will help you pinpoint that.

 

How practice size affects fees

 
New patient (99204)
Established patient (99213)
Fee
Actual payment
Fee
Actual payment
Solo practice
$145
$100
$65
$47
2 doctors
145
108
60
46
3 doctors
140
105
65
50
4 doctors
150
107
70
48
5-9 doctors
152
108
65
48
10-24 doctors
163
108
65
49
25-49 doctors
138
100
75
49
50 doctors or more
186
134
75
50
Doctors in single-specialty groups
150
107
65
49
Doctors in multispecialty groups
160
110
68
48
Doctors in salaried groups
155
114
65
50

 

 

What doctors in 10 fields charge for office visits

 
New patient
99201
99202
99203
99204
99205
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Cardiologists (invasive)
$70
$35
$95
$61
$125
$90
$175
$124
$225
$160
Cardiologists (noninvasive)
60
36
85
60
125
90
165
125
202
150
FPs
50
38
75
58
100
80
144
109
180
135
Gastroenterologists
60
38
85
60
120
84
165
115
200
150
GPs
50
35
70
55
95
70
130
100
160
120
General surgeons
56
38
75
57
105
80
148
110
195
140
Internists
55
40
80
60
109
80
150
110
188
140
Ob/gyns
65
40
85
60
114
78
150
105
195
135
Orthopedic surgeons
65
39
90
60
120
84
160
110
220
150
Pediatricians
56
40
77
56
100
75
130
90
170
120
All primary care
55
40
78
58
103
80
145
103
180
133

 

 
New patient
99211
99212
99213
99214
99215
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
Cardiologists (invasive)
$32
$19
$50
$35
$70
$50
$100
$75
$150
$110
Cardiologists (noninvasive)
35
23
52
35
70
50
100
75
150
102
FPs
30
20
48
35
60
47
90
71
130
100
Gastroenterologists
35
21
50
35
66
48
95
70
142
100
GPs
30
20
45
35
56
45
80
61
110
87
General surgeons
35
22
50
35
66
48
93
71
140
100
Internists
32
21
50
35
68
48
95
70
135
100
Ob/gyns
35
21
51
35
70
48
100
70
140
95
Orthopedic surgeons
38
25
52
34
71
48
100
72
145
100
Pediatricians
31
22
48
35
62
48
90
65
128
90
All primary care
32
20
50
35
65
48
92
70
130
100

 

 

Fees are also affected by . . .

 
New patient (99204)
Established patient (99213)
Fee
Actual payment
Fee
Actual payment
Inner city
$150
$100
$67
$45
Urban
150
110
67
49
Suburban
150
106
65
48
Rural
140
109
60
47
Male
$150
$75
$65
$48
Female
150
74
68
49
30-34
$140
$100
$63
$50
35-39
150
110
68
49
40-44
150
110
68
49
45-49
150
110
65
48
50-54
149
100
65
47
55-59
150
100
62
45
60-64
145
107
61
48
65-69
150
110
65
47
70+
126
96
60
45

 

Internists lose ground; FPs gain

 
Internists
Cardiologists (invasive)
Cardiologists (noninvasive)
Median fee (change since 2001)
$55 (–8%)
$60 (–8%)
$60 (–8%)
Median reimbursement (change since 2001)
30 (–6%)
27 (–7%)
29 (–9%)
 
Internists
FPs
Gastroenterologists
Median fee (change since 2001)
$186 (+6%)
$200 (+20%)
$200 (no change)
Median reimbursement (change since 2001)
100 (no change)
110*
100 (+11%)

 

   

Typical charges and reimbursements in five specialties

 
Fee (change since 2001)
Actual payment (change since 2001)
History & examination of normal newborn (99431)
$150 (+3%)
$97 (–3%)
Immunization, DTaP (90700)
35 (no change)
25 (+9%)
MMR virus vaccine, live (90707)
50 (no change)
38 (+6%)
Circumcision, clamp, newborn (54150)
180 (+20%)
145 (+45%)
Circumcision, clamp, newborn (54150)
$200 (no change)
$110 (+10%)
Total hysterectomy, abdominal (58150)
2,525 (–3%)
1,190 (–1%)
Complete OB care, routine, vaginal delivery (59400)
2,500 (no change)
1,774 (+4%)
Complete OB care, routine, w/cesarean section (59510)
3,000 (+4%)
1,897 (+5%)
Dilation & curettage, diagnostic and/or therapeutic (non-ob) (58120)
650 (–5%)
300 (+5%)
Induced abortion, by dilation & curettage (59840)
708 (–6%)
315 (–10%)
Dilation & evacuation for induced abortion, by (59841)
800 (–1%)
4002
Laparoscopy, surgical, with fulguration of oviducts (58670)
1,300 (+5%)
500 (–12%)
Colposcopy (vaginoscopy); LEEP (57460)
669 (+3%)
250 (–4%)
Upper gastrointestinal endoscopy, diagnostic (43235)
$525 (+5%)
$200 (–9%)
Liver biopsy, needle; percutaneous (47000*)1
312 (+4%)
138 (–8%)
Dilation of esophagus, by unguided sound or bougiesingle or multiple passes (43450*)1
200 (no change)
100 (no change)
Total hysterectomy, abdominal (58150)
$2,4002
$1,0462
Appendectomy (44950)
1,300 (+8%)
600 (+5%)
Laparoscopy, surgical; appendectomy (44970)
1,450 (+2%)
640 (+7%)
Cholecystectomy (47600)
1,918 (+1%)
895 (+12%)
Laparoscopy, surgical; cholecystectomy (47562)
2,400 (+3%)
868 (+2%)
Initial inguinal hernia repair, age 5 or over; reducible (49505)
1,200 (+7%)
550 (+16%)
Gastrectomy/partial, distal—with gastroduodenostomy (43631)
2,750 (+10%)
1,250 (+14%)
Modified radical mastectomy (19240)
2,385 (+8%)
1,000 (no change)
Excision of cyst or fibroadenoma frombreast tissue, one or more lesions (19120)
798 (+11%)
391 (+12%)
Colles’ fracture, closed manipulation (25605)
$750 (no change)
$450 (+12%)
Open treatment of hip fracture (27244)
3,000 (+9%)
1,171 (–3%)
Knee arthroscopy with meniscectomy (29881)
2,265 (+1%)
900 (+8%)
Total hip arthroplasty (27130)
4,778 (+5%)
1,600 (–6%)
Diagnostic knee arthroscopy (29870)
1,118 (+5%)
523 (+10%)
Total knee arthroplasty (27447)
4,677 (–4%)
1,700 (–6%)
Arthrocentesis of knee (20610*)1
115 (+15%)
65 (no change)

 

Physicians receive no extra reimbursement for hospital care

 
99221
99222
99223
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
FPs
$106
$70
$150
$110
$195
$145
Gastroenterologists
120
73
168
106
205
147
GPs
100
66
130
100
175
126
Internists
115
65
150
98
194
125
  
99231
99232
99233
Fee
Actual payment
Fee
Actual payment
Fee
Actual payment
FPs
$60
$38
$80
$55
$109
$79
Gastroenterologists
60
36
80
55
112
75
GPs
55
39
75
56
100
75
Internists
60
35
80
55
105
75
Pediatricians
70
45
90
60
120
80

 

How cardiologists are doing

Median fee (change since 2001)
$400 (no change)
Median reimbursement (change since 2001)
190 (–11%)
Median fee (change since 2001)
$500 (no change)
Median reimbursement(change since 2001)
152 (+1%)
Median fee (change since 2001)
$900 (+12%)
Median reimbursement (change since 2001)
259 (–14%)
Median fee (change since 2001)
$275 (+10%)
Median reimbursement (change since 2001)
47*
Median fee (change since 2001)
$200 (no change)
Median reimbursement (change since 2001)
31 (–31%)

 

A Medical Economics Web exclusive

Office-visit fees around the country

 
East
South
Midwest
West
 
Fee
Actual Payment
Fee
Actual Payment
Fee
Actual Payment
Fee
Actual Payment
Cardiologists
$175
$120
$160
$123
*
*
*
*
FPs
145
100
130
100
$145
$114
$160
$110
Gastroenterologists
167
108
160
120
*
*
*
*
GPs
*
*
130
100
130
*
135
98
General internists
*
*
150
*
*
*
*
*
Ob/gyns
150
83
150
105
143
122
162
110
Pediatricians
125
85
124
100
137
*
140
*
All respondents
150
95
145
105
145
111
160
118
Cardiologists
75
51
70
49
*
*
*
*
FPs
65
49
60
47
60
48
65
45
Gastroenterologists
75
48
66
47
65
*
64
*
GPs
*
*
55
45
53
*
60
45
General internists
*
*
71
45
*
*
*
*
Ob/gyns
80
45
68
46
67
50
75
50
Pediatricians
63
50
60
47
63
46
65
53
All respondents
68
48
65
46
61
49
70
50

 

How this year's fee survey was conducted

Questionnaires for this year's Medical Economics Continuing Survey were mailed in late May to 32,450 MDs and DOs in private, office-based practice throughout the US. This represents a random sampling of 9 selected specialties from the AMA master list maintained by Access Worldwide-the Phoenix Marketing Group.

By the early August cutoff date, 4,055 MDs and DOs had responded. After we set aside returns with apparent discrepancies and those from physicians who hadn't been providing office-based patient care in 2002, our working sample consisted of 2,614 physicians. These were coded by Medical Economics Research services' staff and then tabulated by Suzane Coopersmith of Crosstabs, Inc., in Syosset, NY.

The survey sample was selected so as to be representative within each specialty as to type of practice, age, geographical region, and gender. The results were weighted to reflect these criteria.

The survey was developed and fielded under the direction of Sandy Johnson, Manager of Field Services.

 

Wayne Guglielmo. New Fee Survey: Bridging the reimbursement gap. Medical Economics 2002;21.

Recent Videos
Scott Dewey: ©PayrHealth