Does Medicare reimbursement favor surgeons?

It is a widely held perception that Medicare reimbursement favors surgeons and physicians that perform procedures over physicians who do not. But, a recent study published in the Annals of Surgery may dispel that common assumption, according to a Science Codex report.

The University of Michigan Medical School researchers performed an analysis of the Medicare Physician Fee Schedule and found that the rate which surgeons are paid per minute to perform a procedure is comparable to the rate physicians are paid per minute for an office visit.

The study authors demonstrate that the difference in pay is due rises based on RVUs. The difference in RVUs is explained by the different time estimates applied to different types of physician work.

"Our main interest in performing this work was not to identify outliers, but more simply assess if the large difference in pay among specialties could be explained by difference in payment per time per service," said lead author Kevin Kerber, MD, MS, according to the report. "What this research shows is that the largest and most influential payer in healthcare – Medicare – and the panel doctors that advises them – the RUC – are not overtly setting payment rates higher for surgeons and proceduralists than primary doctors."

Other possible reasons for the pay discrepancy between surgeons and primary doctors could include:

•    Difference in work hours
•    Alternative income sources  
•    Consulting work
•    Administrative work

The study authors still believe that the pay gap is not fully explained. "Some students will choose a high-income surgical specialty over primary or cognitive care, even if their passion is really with office-based work. That is a problem because our payment system is largely dis-incentivizing some of the most important careers in medicine," said Dr. Kerber, according to the report.

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