Payments Up for PCPs, Down for Orthopedists, Surgeons

Marcia Frellick

July 07, 2015

Primary care physicians (PCPs) saw the biggest increase in payments made by insurance carriers to providers in a comparison among several major specialties, according to a new study published in the July issue of Health Affairs.

PCPs came out on top in increased payments for both new patients (3.8%) and established patients (3.4%). New patients were defined as those who had not visited the practice in the 24 months before the visit date. Obstetricians-gynecologists were next highest in increased payments for established patients, with 2.9%. However, the payments for new obstetrics-gynecology patients dipped 0.1%.

To estimate changes in provider payment, researchers analyzed data from 17 million visits among 15,000 office-based physicians that were included in ACA-View, a joint project of RWJF and Athenahealth, a healthcare software and services company. The authors, led by Katherine Hempstead, PhD, a director at the Robert Wood Johnson Foundation (RWJF) in Princeton, New Jersey, and a visiting research assistant professor in the Rutgers Center for State Health Policy in New Brunswick, New Jersey, compared data from January 2013 to September 2013 with those from January 2014 to September 2014.

Contrary to increased payments for PCPs and obstetrics-gynecology, the authors found that payments to orthopedics were down 2.8% for established patients and 3.7% for new patients. Surgeons also saw a decline, with a 1.3% drop for established patients and a 0.8% drop for new patients.

When viewed across all specialties, the researchers saw modest gains, with an increase of 2.0%, on average, for established patients and 1.4% for new patients.

Differences in reimbursement trends in this report may reflect some broader changes in insurer strategy.

Bigger increases for PCPs may come from a couple of factors, the authors say: "First, the Affordable Care Act requires that patients not be required to pay out of pocket for selected preventive care services, which may fall disproportionately into primary care. Second, the relative increase in primary care payments may reflect an insurer strategy to encourage the use of primary and preventive care while reducing the use of specialty care."

Dr Hempstead, who directs coverage issues at RWJF, said in a foundation news release that the seemingly more generous reimbursements for primary care physicians "may reflect new carrier strategies such as patient-centered medical homes."

Future implications for all providers are unclear. They may shun networks with declining payments from insurers, or the payment pressures may spur innovation in delivering care more efficiently, the authors say.

The report also looked at patient obligations in paying for their care. Across all specialties, the report found that between 2013 and 2014, the mean patient obligation increased by 3.5% for established patients and 2.7% for new patients. The increase in obligations was driven almost entirely by growth in deductibles, the authors said, increasing 9.5% for established patients and 7.9% for new patients.

Funding was provided by the Robert Wood Johnson Foundation. The authors have disclosed no relevant financial relationships.

Health Affairs. 2015;34:1220-1224.


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