Medicare Payments: Where Do Neurologists Stand?
About 60%
of Medicare payments to neurologists in 2012 were for evaluation and
management (E/M) services, new data show, and the median neurologist
received almost 75% of his or her Medicare payments from such services,
ranging up to 100% for some.
This new insight into neurology payments comes from provider- and service-level payment data for fee-for-service Medicare beneficiaries recently released by the Centers for Medicare & Medicaid Services (CMS).
The data provide a first look at the healthcare payment landscape, said Kevin Kerber, MD, associate professor, neurology, University of Michigan, who along with colleagues described their findings in a paper published online April 1 in Neurology.
"There was nothing previously available in the medical literature that described the neurology workforce in the US, at least in terms of how neurologists get paid by Medicare."
The annual salary of doctors who mostly provide E/M
services is "substantially less" than that of physicians who do mostly
procedures and tests, Dr Kerber said. Although in terms of services
provided, neurologists are presumed to lie between office-based primary
care doctors and surgeons whose practice is heavy on operating
procedures, in fact, these new data indicate that neurologists are more
in line with primary care doctors because their principal payment
sources are E/M services rather than procedures or tests.
But while primary care and other doctors can take advantage of policies that increase payments for E/M services, neurologists can't.
"There is a movement in the US to try to incentivize more E/M-based care, in the belief that those services have been undervalued, and to try to disincentivize surgeries and tests, particularly those that aren't necessary," said Dr Kerber. "Neurologists were not included in the efforts to try to incentivize that kind of care even though they are E/M-based providers caring for patients with conditions such as Alzheimer's disease, Parkinson's disease, and stroke."
One policy is a Medicare bonus to those treating patients 65 years and older, which was part of the 2010 Affordable Care Act, and the other is a "Medicaid bump" that boosts payments for care rendered to mostly low-income patients to equal that of Medicare payments. In essence, these policies provide a bonus of an additional 10% for the relevant office-based services, said Dr Kerber.
"The reality of the policies is that payments go up for these other doctors who may be seeing the same type of patient as me, and may even have referred the patient to me," said Dr Kerber. "They're getting an extra bonus to incentivize that care and neurologists aren't."
Total Paid
The data come from the CMS Physician and other Supplier Public Use File (POSPUF), which reports Medicare Part B payments organized by providers who submitted claims in 2012.
The POSPUF contained data on 857,693 providers, including 12,317 neurologists, which is an estimated 90% of adult neurologists in the United States. The total amount paid to healthcare providers for CPT (Current Procedural Terminology) codes in 2012 was $64.26 billion, of which 1.8% ($1.15 billion) was paid to neurologists.
2 more pages at link.
This new insight into neurology payments comes from provider- and service-level payment data for fee-for-service Medicare beneficiaries recently released by the Centers for Medicare & Medicaid Services (CMS).
The data provide a first look at the healthcare payment landscape, said Kevin Kerber, MD, associate professor, neurology, University of Michigan, who along with colleagues described their findings in a paper published online April 1 in Neurology.
"There was nothing previously available in the medical literature that described the neurology workforce in the US, at least in terms of how neurologists get paid by Medicare."
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Dr Kevin Kerber
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But while primary care and other doctors can take advantage of policies that increase payments for E/M services, neurologists can't.
"There is a movement in the US to try to incentivize more E/M-based care, in the belief that those services have been undervalued, and to try to disincentivize surgeries and tests, particularly those that aren't necessary," said Dr Kerber. "Neurologists were not included in the efforts to try to incentivize that kind of care even though they are E/M-based providers caring for patients with conditions such as Alzheimer's disease, Parkinson's disease, and stroke."
One policy is a Medicare bonus to those treating patients 65 years and older, which was part of the 2010 Affordable Care Act, and the other is a "Medicaid bump" that boosts payments for care rendered to mostly low-income patients to equal that of Medicare payments. In essence, these policies provide a bonus of an additional 10% for the relevant office-based services, said Dr Kerber.
"The reality of the policies is that payments go up for these other doctors who may be seeing the same type of patient as me, and may even have referred the patient to me," said Dr Kerber. "They're getting an extra bonus to incentivize that care and neurologists aren't."
Total Paid
The data come from the CMS Physician and other Supplier Public Use File (POSPUF), which reports Medicare Part B payments organized by providers who submitted claims in 2012.
The POSPUF contained data on 857,693 providers, including 12,317 neurologists, which is an estimated 90% of adult neurologists in the United States. The total amount paid to healthcare providers for CPT (Current Procedural Terminology) codes in 2012 was $64.26 billion, of which 1.8% ($1.15 billion) was paid to neurologists.
2 more pages at link.
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