Higher Paid Docs Earn More Money From More Procedures

Not for unique patient encounters

TUESDAY, Dec. 9, 2014 (HealthDay News) -- High-income doctors make more money by ordering more procedures for each patient rather than by seeing more patients, according to an analysis of 2012 Medicare data published in a research letter Dec. 8 in JAMA Internal Medicine.

Jonathan Bergman, M.D., M.P.H., an assistant professor of urology and family medicine at the University of California in Los Angeles, and colleagues analyzed data released by the Centers for Medicare & Medicaid Services to determine the causes of wide variation in payments to physicians. The ratio of the number of services provided to individual beneficiaries to total Medicare Part B payments, as well as the ratio of submitted charges, by decile, from lowest to highest Medicare recipients in calendar year 2012 were provided.

The authors determined that higher compensation resulted not by treating more patients but by offering more services per beneficiary. For each service offered by a physician in the bottom decile, five are offered by a physician in the upper decile. The 20th, 40th, 60th, and 80th deciles for the services to beneficiary ratios are 1.4, 2.2, 3.6, and 6.9. Of all payments made, 22 percent were for outpatient visits, 11 percent were for hospital care, 3 percent were for emergency department visits, and 64 percent were for other services.

"These findings suggest that the current health care reimbursement model -- fee-for-service -- may not be creating the correct incentives for clinicians to keep their patients healthy. Fee-for-service may not be the most reasonable way to reimburse physicians," Bergman said in a university news release. "Perhaps it would make more sense to reimburse clinicians for providing high-quality care, or for treating more patients. There probably shouldn't be such wide variation in services for patients being treated for the same conditions." Additional research is needed to find out if patients who undergo more procedures have better outcomes than those who have fewer, Bergman said. He and his colleagues plan to examine alternatives to the current fee-for-service payment approach.

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