Anesthesiologists, certain radiologists and emergency medicine
doctors were among the medical specialists who often charged four to
six times more than what they accept from Medicare for the same
services, researchers found.
"I want to raise awareness of some specialists' profit-driven
behaviors," said lead author Ge Bai, of the Johns Hopkins Carey
Business School in Baltimore. "Then, we can look for solutions."
News reports of patients receiving surprisingly high medical bills
after surgeries and other healthcare services led Bai to investigate
what doctors accepted from Medicare for those services and what they
charged other patients.
For example, a patient with private insurance may go for surgery to
a hospital that accepts their health insurance, but one of the
doctors involved in their care isn't in their insurer's network. The
patient will likely get a very high bill from that out-of-network
doctor later on.
Bai and Gerard Anderson of the Johns Hopkins Bloomberg School of
Public Health analyzed Medicare data on 429,273 doctors in 54
different medical specialties.
According to the website of the Kaiser Family Foundation, a
non-profit organization focusing on national health issues, Medicare
payments are based on the average costs of providing care to a
Medicare patient, as well as other provider expenses such as
malpractice insurance. Medicare's fee schedule, however, is subject
to a formula designed to control government spending that calls for
regular cuts in physician payments. To prevent these cuts,
policymakers have overridden the formula multiple times.
Bai and Anderson calculated so-called excess charges from doctors by
dividing the amount providers accept from Medicare by the price they
charge other patients for the same service.
Overall, half of the doctors charged 2.5 times what Medicare paid
for the same services.
Half of doctors specializing in general or internal medicine, family
practice, psychiatry, dermatology, allergy and immunology and
geriatric medicine charged 1.6 to 2 times more than what Medicare
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On the other end of the spectrum, half of anesthesiologists charged
patients about 6 times more than what they accepted from Medicare
for the same services. Half of interventional radiologists charged
at least 4.5 times more than what they accepted from Medicare.
Emergency medicine doctors charged 4 times more than what Medicare
"We were really surprised by the systematic pattern," said Bai. "The
(physicians) patient donít have the option to choose have much
higher markups than . . . physicians that patients have the option
For example, a person can likely shop around for a general or family
physician, but a person having a heart attack probably can't shop
around to find an anesthesiologist or interventional radiologist.
If those doctors with high excess charges are out of a patient's
network, they may end up with a high bill later on.
The researchers also found that these excess charges varied by state
Bai said people can prevent high medical bills from these excess
charges by asking hospitals if every healthcare provider involved
with their care will be in their insurance network.
Additionally, she said, laws like one passed in New York in 2014
that limit out-of-network costs for emergency medical services may
help people avoid crushing expenses.
"The problem is that the public and policymakers donít realize such
a big problem exists here," she told Reuters Health.
SOURCE: http://bit.ly/2jlo8MH JAMA, online January 17, 2017.
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