Service Intensity and Physician Income

Service Intensity and Physician IncomeConclusions From Medicare’s Physician Data Release ONLINE FIRST

Jonathan Bergman, MD, MPH1,2,3; Christopher S. Saigal, MD, MPH1,3,4; Mark S. Litwin, MD, MPH1,5
JAMA Intern Med. Published online December 08, 2014. doi:10.1001/jamainternmed.2014.6397
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These data indicate that higher-earning physicians earn more not by treating more patients but by offering more services per beneficiary. The relationship between these additional services and any meaningful improvement in outcomes is undefined. Given the data on medical service utilization in the United States, it is likely that a substantial portion of these services is unrelated to improved outcomes. For each service offered by a physician in the bottom decile, 5 are offered by a physician in the upper decile. The 20th, 40th, 60th, and 80th deciles for the services to beneficiary ratios are 1.4, 2.2, 3.6, and 6.9 (demarcated as quintiles of services [dashed lines in the Figure]), respectively, highlighting tremendous overall variation in the number of services physicians offer each beneficiary. In Medicare’s fee-for-service system, some physicians are collecting large fees by ordering services munificently.

Part of the point is… that if you *aren’t* offering some of those procedures, maybe you should be.  I have found from some of my analysis that higher Medicare revenue earning primary care docs tend to:

work hard (see lots of patients)
do nursing home care,
and do *home visits* which pay about twice as much as a nursing home visit

In an analysis of Ohio physicians, I did find one physician in Cleveland who billed for 5,420 home visits in 2012…  I am assuming that this might be some sort of proxy billing through midlevels, because 5,420 home visits would come to over 20 some visits per day for a 48-50 week 5 day year, and that wouldn’t seem possible *unless* maybe the physician was billing for “home visits” in a nursing/retirement care setting.

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