Medicare reimburses physicians up to five times more for performing common procedures than for cognitive care, allowing specialists to generate more revenue in an hour or two than a primary care physician makes in a day, a new study published online by JAMA Internal Medicine finds.
A physician makes 368 percent more doing a colonoscopy than spending the same amount of time on cognitive care, according to the study abstract. The reimbursement for removing a cataract is 486 percent higher than comparable cognitive care.
The study "illustrates the financial pressures that may contribute to the U.S. healthcare system's emphasis on procedural care," the researchers conclude.
The study also finds fault with Medicare calculations for the amount of time required to perform the outpatient procedures, reports Medscape Today. The Centers for Medicare & Medicaid Services assumes a physician spends 30 minutes in a screening colonoscopy, plus another 45 minutes pre- and post-op. The study found the actual time involved totals 23.5 minutes.
The payment gap encourages specialists to favor revenue-generating procedures over cognitive-oriented care, the authors argue, and discourages careers in primary care.
The study notes private insurers tend to mirror Medicare's payment policies, making "the tilt toward procedure-oriented care ... even more pronounced," Medscape Today reports.