Navigation Links
Study suggests eliminating Medicare consultation payments associated with a net increase in spending

CHICAGO A study of Medicare claims data suggests that eliminating payments for consultations commonly billed by specialists was associated with a net increase in spending on visits to both primary care physicians and specialists, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

Before 2010, Medicare payments for consultations were substantially higher than for office visits of similar complexity that were commonly billed by primary care physicians (PCPs). In January 2010, Medicare eliminated consultation payments from the Part B Physician Fee Schedule and increased fees for office visits. The change was intended to be budget neutral because it would decrease payments to specialists but increase payments to PCPs, according to the study background.

Zirui Song, Ph.D., of Harvard Medical School, Boston, and colleagues examined the relationship of this policy with spending, volume and coding for office visits in the first year of implementation. Researchers examined outpatient claims from 2007 through 2010 for more than 2.2 million Medicare beneficiaries with Medicare Supplemental coverage through large employers.

"Medicare's elimination of consultations was associated with a 6.5 percent increase in overall spending for outpatient encounters in 2012. This increased spending was explained by higher fees paid for office visits and by increased intensity of coding. Our results suggest that the policy did not achieve its goal of budget neutrality in the first year. However, it did appear to narrow the gap in Medicare payments for office encounters between PCPs and specialists," the authors comment.

Researchers note that an average of $10.20 more was spent per beneficiary per quarter on physician encounters after the policy (6.5 percent increase), but the total volume of physicians visits did not change significantly. The increase in spending was largely explained by higher office-visit fees from the policy and a shift toward higher-complexity visits to bother specialists and PCPs, according to the study results.

"Our evaluation of Medicare's elimination of consultations offers potential lessons for policymakers. Primarily, the volume effects associated with fee cuts will depend on the nature of the service," the authors conclude. "Finally, the inherent flexibility and subjectivity of code definitions could lead to potentially undesirable coding behavior in response to fee-based policies, as numerous areas in the physician fee schedule feature a gradient of service intensities captured by a set of closely related codes."

(Arch Intern Med. Published online November 26, 2012. doi:10.1001/jamainternmed.2013.1125. Available pre-embargo to the media at

Editor's Note: Research for this article was supported by The Commonwealth Fund and another author disclosed support. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Getting Primary Care Right

In an accompanying editorial, Patrick G. O'Malley, M.D., M.P.H., of the Uniformed Services University, Bethesda, Md., writes: "Primary care has been marginalized, and our own professional societies have encountered numerous obstacles in advocating for the preeminence of primary care."

"Fix the pay differential, and make providers' lives easier. How to do this may seem complicated, but it is not. The main barrier is for our professional leadership at every level, whether in the clinic, hospital, medical school, health system, professional society, government agencies or society in general, to acknowledge the problem and then take responsibility and act," O'Malley continues.

"We need a more definitive and more intentional workforce policy plan, and given the current morale of our adult primary care workforces, it will have to involve higher and more parity in pay as well as substantial improvement in work hours and working environment," O'Malley concludes.

(Arch Intern Med. Published online November 26, 2012. doi:10.1001/.jamainternmed.2013.1124. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


Contact: David Cameron
JAMA and Archives Journals

Related medicine news :

1. Study Suggests Vaccine May Help Kids With Brain Cancer
2. Study reveals how cancer drug causes diabetic-like state
3. Coffee Drinking in Pregnancy Wont Lead to Sleepless Baby: Study
4. Lower GI problems plague many with rheumatoid arthritis, Mayo Clinic study finds
5. Veggies Like Broccoli, Cabbage May Help Fight Breast Cancer: Study
6. No Added Cancer Risk From Hip Replacement Materials: Study
7. Reported Decline in U.S. Pneumonia Deaths May Be False: Study
8. Early Study Finds Some Promise for Lung Cancer Vaccine
9. Narcissists Often Ace Job Interviews, Study Finds
10. Sexual objectification of female artists in music videos exists regardless of race, MU study finds
11. Soy may alleviate hot flashes in menopause, large-scale study finds
Post Your Comments:
(Date:12/1/2015)... ... December 01, 2015 , ... Trustify is proud to announce the success ... Becky’s Fund, an organization dedicated to ending domestic violence. , Trustify and Becky’s Fund ... victims and survivors of domestic violence. Trustify is also proud to announce the launch ...
(Date:12/1/2015)... ... December 01, 2015 , ... World Patent Marketing , ... a container patent that allows for easier packing and organizing of items into one ... $90 billion," says Scott Cooper, CEO and Creative Director of World Patent Marketing and ...
(Date:12/1/2015)... ... December 01, 2015 , ... Integrated Rental Services ... Jordan Industries International, LLC (“JII”). , With support from JII, Integrated Rental is ... to hospitals, surgery centers, clinics, research labs and medical facilities across the United ...
(Date:12/1/2015)... (PRWEB) , ... December 01, 2015 , ... ... of leadless pacemakers in the U.S. and is the only hospital in the ... the largest clinical data presentation of transcatheter pacing patients were revealed recently at ...
(Date:12/1/2015)... ... December 01, 2015 , ... Growth in medical payments per workers’ compensation claim ... of hospital and nonhospital care, according to a recent study by the Workers Compensation ... Edition , found medical payments per claim with more than seven days of lost ...
Breaking Medicine News(10 mins):
(Date:12/1/2015)... 1, 2015 --> ... Drugs Market by Type of Drug (Monoclonal Antibodies, Interferon-Alpha, Interleukins, ... and Pipeline Analysis - Global Forecast to 2020", published by ... USD 73,529.2 Million by 2020 from USD 40,281.6 Million in ... Browse 37 market data ...
(Date:12/1/2015)... BANGALORE, India and ... (NASDAQ, TASE: MYL) today announced that it expects to ... for developing country markets funded by international donors, TLE400 ... + Efavirenz 400 mg) for $99 per patient, per ... (CHAI) to develop TLE400. The significantly reduced price could ...
(Date:12/1/2015)... 1, 2015  AccuTEC Blades, a leader in ... logo and brand identity program. The new logo ... of bladed products where "the edge makes all ... --> Serving manufacturers and distributors of medical, ... equipment, AccuTEC,s product lines include those acquired when ...
Breaking Medicine Technology: