Study: Payments to physicians up
New research data show modest increases in payments to physicians, as well as out-of-pocket costs by patients across the United States, as health insurance plans shift more costs to patients with higher deductibles.
The findings come out of a research initiative between the Robert Wood Johnson Foundation and athenahealth Inc., of Watertown. Among the most notable findings:
- Physician reimbursement from commercial insurance carriers increased, on average, 2 percent between 2013 and 2014 for established patients and 1.4 percent for new patients.
- The proportion of health care costs paid directly by patients increased 3.5 percent for established patients (roughly $1 per physician visit) and 2.7 percent for new patients (roughly $1.20 per visit).
- Primary care physicians are seeing slightly increased payment levels from insurance carriers compared with most specialists included in the study.
The findings are reported in the July 15 issue of Health Affairs as part of its DataWatch series, according to a statement from the two organizations. The data are derived from 15,000 office-based physicians, a subset of athenahealth's cloud-based network of more than 65,000 health care providers and 62 million patients across the U.S.
"The moderate increase we observed in physician payments is consistent with low overall price increases for health care services that have been reported elsewhere," said Kathy Hempstead, who directs coverage issues at the Wood foundation, based in Princeton, N.J. "The relative shift toward more generous reimbursements for primary care providers may reflect new carrier strategies such as patient-centered medical homes, or perhaps the new cost-sharing structure for preventive care.
“The increases seen in patient obligations reflect the evolving pattern of benefit designs toward higher deductibles and an increasing share of covered services which are subject to the deductible," Hempstead said.
The data analysis for the findings looked at average provider reimbursement across primary care, surgery, orthopedics, and OB-GYN, plus patients' payment obligations between January and September in 2013 and 2014.
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