Cover Story

SURVEY REPORT

What you charge vs what you get

Here's the latest update on fees and reimbursements in primary care—and the gaps between them.

By Mark Crane
Senior Editor

With relatively few exceptions, reimbursements this year for medical services and procedures are flat or sinking. That's been true for at least five years, according to the latest Medical Economics Continuing Survey, which samples MDs and DOs in office-based private practice.

Once again, third-party payers give physicians less than half their fees for most CPT codes for major procedures and services. For example, cardiologists typically receive $30 of the median $65 they charge for an ECG with interpretation and report.

The decline in reimbursements in the surgical fields continues. Despite relatively modest fee increases, actual reimbursements fell yet again this year for ob/gyns, general surgeons, and orthopedic surgeons.

The news is better for office visits, but not by a lot. While actual payments still lag behind physician fees, there has been some improvement. On average, doctors receive about 75 percent of their actual charges.

General internists raised median initial office visit fees in all five CPT codes by an average of $5.40. Reimbursements were up $3 for 99201 and 99202, but remained the same for more-extensive visits. For established patients, internists raised median fees by $3.20 on average, while actual payments declined by about 40 cents. Median fees for ECGs rose by $5, while reimbursement stayed the same. The pattern was reversed for sigmoidoscopy: Internists raised their median charge by $3, but the median reimbursement climbed by $5.

Family physicians raised median initial office visit fees by $4 on average, while actual payments went up an average of $3. For revisits, fees rose by an average of $4.20, but reimbursement climbed by $3.80. For hospital care, however, FPs raised median fees by almost $6 per code, while reimbursement went up by an average of almost $7.

GPs' initial office visit fees rose in three codes and declined in two, for no change on average. Reimbursement was also unchanged. For revisits, median fees rose $1.80 on average, while actual payment rose by $1.60.

Pediatricians raised median initial office fees by an average of $6, while reimbursement rose $4.20. For established patients, the increases were $5.40 for fees and $4.40 for reimbursements. Median hospital fees rose by $1.67 on average, while reimbursement was $3 higher. Median fees rose 4 percent for three of pediatricians' four major services, but there was little change in reimbursement.

Invasive cardiologists raised median initial office fees by an average of $12.80, while reimbursement rose $6.70. For revisits, median fees increased by $5.60, while actual payment went up $7.25 on average. Noninvasive cardiologists raised median initial office fees by an average of almost $17 per code, but received only $6.50 in additional reimbursement. For revisits, median fees rose by an average of $8.25, while reim- bursements went up only about $3. For six major cardiology services we surveyed, median fees increased by 4 percent, but reimbursements declined or remained the same as last year.

Ob/gyns raised median initial office fees by an average of $8.40, but reimbursement increased $4.40. For revisits, median fees were up $1.40, while actual payments rose by $2. For nine major procedures, median fees rose by an average of 10 percent, while reimbursements declined by 3 percent.

How do your fees and reimbursement levels stack up against the norms set by colleagues in your specialty and size of practice? See the accompanying tables, and commentaries. For a description of how the survey was conducted, see "Earnings: Time to call a code?".

How practice size affects fee levels

What doctors charge for office visits

Charge ranges: Internists hold their own

The range of fees for cardiologists

Charges for hospital care

A Medical Economics Web Exclusive:
Office-visit fees around the country

Doctors in the West charge the most for new-patient office visits. Their Midwestern colleagues typically charge $15 less, but receive the most in actual payments. For revisits, Western doctors have the highest reimbursements.

Participate with HMOs

140

No participation with HMOs

Participate with PPOs

No participation with PPOs

Participate with HMOs

No participation with HMOs

Participate with PPOs

No participation with PPOs

A Medical Economics Web Exclusive:
How fees vary by type of community

A Medical Economics Web Exclusive:
Typical charges and reimbursements in five specialties

Circumcision, clamp, newborn (54150)

$100 (no change)

Mark Crane. Survey Report: What you charge vs what you get.

Medical Economics

2001;20.