Surgeons, Intensivists Earn More Than Do Colleagues From Private Insurance

Randy Dotinga

April 19, 2023

General and orthopedic surgeons and intensivists earn the highest net reimbursements from private US insurers, a new report estimates.

On average in 2021, they were paid $5.8 million, $4.9 million, and $3.3 million, respectively, according to figures compiled by AMN Healthcare, a Dallas-based health staffing company.

None of 15 other physician specialties topped $3 million in net reimbursement on average, and three — dermatology, pediatrics, and family medicine — didn't reach $1 million.

The report doesn't include data about reimbursement from Medicare and Medicaid, and its numbers assume that 50% of insurance claims are denied. Denial rates differ from practice to practice.

Still, the findings offer a "benchmark tool" to help clinicians understand how they rank against their peers, said Linda Murphy, president of AMN Healthcare's Revenue Cycle Solutions division, in an interview.

This is the first year that the company has calculated physician reimbursement levels by using claim and clearinghouse data, Murphy said. Previously, a division of the firm compiled data by surveying chief financial officers from hospitals.

The report's estimate that insurers deny 50% of claims is "conservative," Murphy said. Miscoding is a significant factor behind that number, she said.

Here are the estimated 2021 net private insurance reimbursements by specialty for direct services, assuming a 50% denial rate:

Anesthesiology: $1,665,510
Cardiology: $1,703,013
Critical Care (intensivist): $3,338,656
Dermatology: $729,107
Family medicine: $697,094
Gastroenterology: $2,765,110
Internal medicine: $1,297,200
Neurology: $1,390,181
Obstetrician/gynecology: $1,880,888
Otolaryngology: $2,095,277
Pediatrics: $661,552
Psychiatry: $1,348,730
Pulmonology: $1,561,617
Radiology: $1,015,750
Rheumatology: $1,705,140
General surgery: $5,834,508
Orthopedic surgery: $4,904,757
Urology: $2,943,381

Among 18 physician specialties overall, the report estimated that the average net reimbursement in 2021 was $1.9 million.

The report also estimates that the net reimbursement amounts at $875,140 for certified registered nurse anesthetists and $388,696 for nurse practitioners.

Surprisingly, Murphy said, there's a "a really large swing" among reimbursement levels for individual specialties. The quartile of cardiologists with the lowest level of reimbursement, for example, submitted $2.1 million in claims in 2021, netting about $1 million at a 50% denial rate vs the $7.3 million made by those in the highest quartile, netting about $3.6 million.

The gap seems to be due to regional variations, she said, adding that a rural cardiologist will have different billing practices than does one practicing in New York City.

The quartile of general surgeons with the highest reimbursement levels billed for $21.1 million on average in 2021, making about $10.5 million at a 50% denial rate. The lowest quartile billed for $5.5 million, making about $2.7 million at a 50% denial rate.

The report notes that primary care physicians, that is, family medicine, internal medicine, and pediatrics specialists, have much lower levels of reimbursement compared with most other specialties. But the work of primary care physicians "may lead to considerable 'downstream revenue' through the hospital admissions, tests and treatment they order," the report noted.

A previous analysis by a division of AMN Healthcare found that primary care physicians, on average, generate $2,113,273 a year in net annual revenue for their affiliated hospitals, nearing the $2,446,429 in net annual hospital revenue generated by specialists.

AMN Healthcare is preparing another report that will examine Medicare reimbursements, Murphy said. According to the new report, payments by nonprivate insurers amount to about one third of the total amount of reimbursement by commercial insurers.

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