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Provider Reimbursements and Patient Share of Payments

By July 17, 2015Commentary

It is difficult to get real data on how much commercial health plans are paying physicians and other providers and how much of the total payment is being paid by patients.  A Health Affairs study uses data from athenahealth’s data base of payments that run through its system to try to identify trends in reimbursements.   (HA Article)   The study covered 2013 and 2014 and was based on providers who were using the athenahealth system since at least 2011.  This tends to result in over-representation of larger practices.  The analysis compared payments for new and established payments for calendar year 2013 and 2014.  The average payment per physician visit increased 2% for established patients and 1.4% for new patients on a year-over-year basis.  Removing the potential effect of intensity by looking only at per relative unit payments reveals at 1.5% rise for established patients and 1.6% for new ones.  Primary care saw the largest increase, at 3.4% for returning patients and 3.8% for new ones.  OB-GYN also experienced growth in payments.  Orthopedics and surgery, however, actually saw a modest decline in average reimbursements.

The average patient portion of total payment increased slightly more rapidly, at 3.5% for established patients and 2.7% for new ones.  Almost all of this came from larger deductibles, which rose 9.5% for established patients and 7.9% for new ones, while copays actually fell and coinsurance stayed relatively flat.  In raw dollar terms, the patient obligation rose from $31.01 in 2013 in the established category to $32.08 in 2014, while the new category went from $44.37 to $45.57 in the same time period.  While established patients had average deductible payments of $17.01, they were $26.60 for new patients.  This suggests that many people who are perhaps getting coverage for the first time have policies with higher deductibles.  As might be expected, the patient payment obligation is much higher for specialty care than for primary care.  The good news is that the report indicates continued slow growth in prices paid to physicians, but the bad news is that consumers are bearing a higher portion of those payments.

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