Pennsylvania Physician Reimbursement Trails Other Regions Says ‘State of Medicine’ Report
While private payer insurance has improved somewhat in the past few years, overall compensation for Pennsylvania physicians and allied health professionals still lags behind the income of their colleagues in other states.
That was one of the findings from “The State of Medicine,” 2007 edition, an exhaustive study of the trends impacting the medical profession and patient care in Pennsylvania.
Medicaid fee-for-service in Pennsylvania pays only half of Medicare rates (i.e. Medicaid pays 50 cents and Medicare pays a $1 for the same medical care), leading some medical practices to stop seeing Medicaid beneficiaries. Medicare rates have remained virtually stagnant while costs like medical school tuition and medical supplies and equipment have continued to rise.
"The thing to keep in mind with physician reimbursement is how it compares with other areas of the country," said Mark A. Piasio, MD, MBA, immediate past president of the Pennsylvania Medical Society. "If we can’t offer competitive salaries and reimbursement in Pennsylvania, then physicians will go someplace where they can build a better life. It’s simple economics."
On the bright side, payment for evaluation and management services (E&M) by two of the Pennsylvania’s largest private payers has improved compared to 2005 numbers. Highmark Blue Shield is now approximately paying 113 percent of Medicare rates and Independence Blue Cross (IBC) is paying 95 approximately percent of Medicare. In the 2005 edition of “The State of Medicine,” Highmark and IBC were paying 105 percent and 85 percent of Medicare respectively for E&M services.
While these rates are certainly an improvement, they still fall below the national average of 123 percent of Medicare paid by private insurers, according to a study by the Center for Health System Change (CHSC). And, when compared to other private payers across the U.S., Pennsylvania’s private payers are either average or below average in payment levels.
Nationally, physician compensation fell 7 percent from 1995 to 2003, says the CHSC study, while other professions’ income rose 7 percent.
“The State of Medicine” uses data from several sources including the Bureau of Labor Statistics to compare physician income in Pennsylvania to other states. Most primary care specialties rank near the bottom nationally. Rankings among selected specialties include:
- Obstetrician/gynecologists – 12th highest compensation of all states
- Anesthesiologists – 30th
- Family Practitioners – 42nd
- Pediatricians – 41st
- Psychiatrists – 38th
- Surgeons – 44th
The Pennsylvania Medical Society will continue to work with Medicaid, Medicare, and private payers like Highmark and IBC to make compensation for physicians' services competitive with other states.
Last Updated: 3/5/2008