Tag Archives: physician payments

Report shows wide variation in what insurers pay providers versus what Medicare would have paid

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Researchers from the Health Care Cost Institute reviewed 210 million claims from individuals with health insurance through their employers in 2017 and compared what insurers paid physicians and other providers for those services against what Medicare would have paid for the same services in 271 metropolitan areas.

Graphic: Health Care Cost InstituteResearchers from the Health Care Cost Institute reviewed 210 million claims from individuals with health insurance through their employers in 2017 and compared what insurers paid physicians and other providers for those services against what Medicare would have paid for the same services in 271 metropolitan areas. (Click to enlarge graphic.)

During the coronavirus pandemic, any number of good news stories seem to get little or no coverage because most health care journalists are busy covering COVID-19.

One such case in point was a report earlier this month from the Health Care Cost Institute. In Comparing Commercial and Medicare Professional Service Prices, HCCI researchers compared what health insurers paid to physicians and other providers with what Medicare pays for those services.

This report should not be overlooked for at least three reasons. Continue reading

CMS data should give reporters a plethora of new stories to cover

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

As Charles Ornstein pointed out, the Centers for Medicare and Medicaid Services announced that it will release payment information for individual physicians in response to Freedom of Information Act requests, beginning in March. The move will increase transparency while still protecting the privacy of Medicare beneficiaries, according to a blog post by Jonathan Blum, principal deputy administrator.

According to a story in Modern Healthcare, the AMA has warned the Obama administration that it will be walking a thin line between balancing physician privacy rights with release of payment data – and that poor execution of the policy could lead to an unfair breach of confidentiality for providers and patients. Continue reading

AHCJ calls for accessible reporting of physician payments

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

The Centers for Medicare & Medicaid Services should create an easily usable and searchable database when it publishes information from drug and device makers about payments to physicians, according to comments (PDF) submitted by the Association of Health Care Journalists  on proposed rules for carrying out the Physician Payment Sunshine Act.

The act will open a window on financial relationships between physicians and industry. Starting in 2013, pharmaceutical and device manufacturers must report to CMS any “transfer of value” worth more than $10 to a physician, and CMS will post the information online.

“Overall, we believe your regulations would faithfully enact the provisions of the Payment Sunshine Act,” AHCJ President Charles Ornstein wrote. “To serve its purpose, the information must be easily accessible to anyone who wants to know about an individual doctor or doctors in a community, as well as for researchers and reporters seeking a larger view.”

The law comes in response to growing concerns that industry payments to doctors can skew prescribing decisions and encourage use of brand-name drugs.

AHCJ made several specific recommendations: provide unique identifiers for each physician, note when a company updates its information, include gifts of textbooks and educational materials in the reporting requirements, and include partial data from 2012.

Additionally, the association noted that because the law applies exclusively to physicians, companies do not have to disclose payments to nurse practitioners and physician assistants. AHCJ urged CMS to consider reporting payments to non-physician prescribers who work in group practices with physicians.

Related

The Pew Prescription Project has a collection of documents about the Physician Payment Sunshine Act.