Nav: Home

Study examines extent, variation of physician excess charges

January 17, 2017

Nearly all physicians charge more than the Medicare program actually pays ("excess charges"), with complete discretion to determine the amount charged. Ge Bai, Ph.D., C.P.A., and Gerard F. Anderson, Ph.D., of Johns Hopkins University, Baltimore, conducted a study to understand the extent and variation of physician excess charges. The study appears in the January 17 issue of JAMA.

High excess charges can impose financial burdens on uninsured patients and privately insured patients using out-of-network physicians. Although some out-of-network physicians may offer discounts from their full charges, many patients receive unexpected medical bills. For this study, the researchers examined Medicare physician use and payment data, including payment and submitted charges for U.S. physicians who provided services to Medicare beneficiaries and submitted Medicare Part B claims in 2014. Physician excess charges were defined as total charges divided by total Medicare allowable amount for medical services (i.e., the charge-to-Medicare payment ratio) for each physician. Specialty and geographic distribution of physicians with high excess charges were defined as physicians with median charge-to-Medicare payment ratios in the top 2.5 percent.

Data from 429,273 individual physicians across 54 medical specialties were included in the study. The researchers found that the median physician charges were 2.5 times higher than what Medicare pays. The authors note that the charge-to-Medicare payment ratio represents the upper limit of each physician's actual excess charge, and may not be what a patient actually pays. The ratio varied across specialties, with anesthesiology having the highest median and general practice having the lowest. Of the 10,730 physicians with high excess charges, 55 percent were anesthesiologists and 3 percent were in general practice, internal medicine, or family practice.

There were also regional differences in excess charges. Two neighboring states (Wisconsin and Michigan) had different median excess charges (3.8 vs 2.0, respectively). About one-third of physicians with high excess charges practiced in only 10 hospital referral regions.

"As the health insurance market shifts toward more restrictive physician networks and high-deductible plans, protecting uninsured and out-of-network patients from high medical bills should be a policy priority. For example, a recent law in New York restricts out-of-network physicians from charging patients excessive unexpected amounts," the authors write.
-end-
(doi:10.1001/jama.2016.16230; the study is available pre-embargo at the For the Media website)

Editor's Note: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

To place an electronic embedded link to this study in your story This link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.16230

The JAMA Network Journals

Related Physicians Articles:

Physicians call for an end to conversion therapy
Historically, conversion therapies have used electroshock therapy, chemical drugs, hormone administrations and even surgery.
Racial bias associated with burnout among resident physicians
Symptoms of physician burnout appear to be associated with greater bias toward black people in this study of nearly 3,400 second-year resident physicians in the United States who identified as nonblack.
Survey finds physicians struggle with their own self-care
Despite believing that self-care is a vitally important part of health and overall well-being, many physicians overlook their own self-care, according to a new survey released today, conducted by The Harris Poll on behalf of Samueli Integrative Health Programs.
Less burnout seen among US physicians, Stanford researcher says
The epidemic levels of physicians reporting burnout dropped modestly in 2017, according to a study by researchers at the Stanford University School of Medicine, the Mayo Clinic and the American Medical Association.
Payments to physicians may increase opioid prescribing
US doctors who receive direct payments from opioid manufacturers tend to prescribe more opioids than doctors who receive no such payments, according to new research published by Addiction.
More Physicians News and Physicians Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...