For physicians, rates nearly the same for Medicare and Medicare Advantage

A new study raises the question of how moving the Medicare program to a premium support model could affect how physicians and other clinicians are paid.

When it comes to payment rates, physicians aren’t seeing much of a difference between traditional Medicare and Medicare Advantage plans, according to a new study.

Medicare Advantage plans managed by private insurers pay doctors prices similar to Medicare rates, according to the study led by University of Southern California researchers, which was published in JAMA Internal Medicine. However, on some services or equipment, commercial insurers have an advantage, the study found.

"With 1 in 3 beneficiaries enrolled in Medicare Advantage, it is important to look under the hood and get a better understanding of how these plans operate," Erin Trish, the study's lead author and an assistant research professor at the USC Schaeffer Center for Health Policy and Economics, said in a university announcement.

"We found that physician reimbursement rates in Medicare Advantage are very similar to traditional Medicare. This is very different than what we see in the commercial insurance market, where insurers tend to pay physicians more than Medicare—sometimes much more,” she said.

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In the study, researchers analyzed a sample of 144 million Medicare, Medicare Advantage and commercial claims from 2007 to 2012 in metropolitan areas and compared reimbursement rates for 11 common procedures. They found mean Medicare Advantage reimbursement rates nearly matched the traditional Medicare rate in many cases, such as the rate for an office visit, which was 97% of the Medicare rate.

Those findings raise the question of how reforms under discussion, which would transition the Medicare program toward a premium support model, could affect how physicians and other clinicians are paid, the study said.

The study also looked at prices paid for commercial insurance patients. In general, commercial insurers paid higher prices for procedures than Medicare. However, for a few services, commercial prices were lower than traditional Medicare.