The skyrocketing cost of health care in the United States may be attributable in part to a huge discrepancy between what Medicare pays physicians for common surgical procedures and what it pays them for primary care visits, say researchers.
In a study published online by JAMA Internal Medicine on Aug. 12, they calculate that Medicare pays surgeons performing cataract extractions 486% of the revenue it pays primary care physicians who treating patients for the same amount of time. Surgeons performing colonoscopies earned 368% of the primary care amount.
"Two common specialty procedures can generate more revenue in 1 to 2 hours of total time than a primary care physician receives for an entire day's work," write Christine A. Sinsky, MD, of Medical Associates Clinic in Dubuque, Iowa, and David C. Dugdale, MD, of the University of Washington in Seattle.
This gap is due in part to the complexities of Medicare's relative value unit-based payment system and in part to the agency's overestimation of the amounts of time that surgeons spend on a case, they argue. The end result is rising costs, especially since commercial insurers often follow Medicare's cues, and demands a revision of the RVUs.
"Historically, U.S. physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health," they write.
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