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Removal of Consultation Fees Increased Spending on Doc Visits

Increase in spending due to higher office-visit fees, complexity; no increase in volume of visits

WEDNESDAY, Nov. 28 (HealthDay News) -- The 2010 Medicare elimination of consultation payments (mainly billed by specialists) led to a net increase in spending on physician office visits, according to a study published online Nov. 26 in the Archives of Internal Medicine.

Zirui Song, Ph.D., from Harvard Medical School in Boston, and colleagues used data from the Thomson Reuters MarketScan Database to examine outpatient claims for 2,247,810 Medicare beneficiaries (2007 to 2010) who had Medicare Supplemental (Medigap) coverage through large employers. The authors sought to assess the impact of elimination of consultation payments on spending, volume, and complexity for outpatient office encounters.

The researchers found that, following the elimination of consultation payments from the Part B Physician Fee Schedule, "new" office visits largely replaced consultations in 2010. Per beneficiary per quarter, an average of $10.20 more was spent on physician encounters after the policy, representing a 6.5 percent increase, although there was no significant change in the total volume of physician encounters. Elevated office-visit fees from the policy and a move toward higher-complexity visits to both specialists and primary care physicians accounted for the increase in spending.

"The elimination of consultations led to a net increase in spending on visits to both primary care physicians and specialists," the authors write. "Higher prices, partially owing to the subjectivity of codes in the physician fee schedule, explained the spending increase, rather than higher volumes."

Several authors disclosed financial ties to the pharmaceutical and health insurance industries.

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