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Original Investigation | Health Care Reform

Medicare Payment for Cognitive vs Procedural Care:  Minding the Gap

Christine A. Sinsky, MD1; David C. Dugdale, MD2
[+] Author Affiliations
1Department of Internal Medicine, Medical Associates Clinic PC, Dubuque, Iowa
2Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle
JAMA Intern Med. 2013;173(18):1733-1737. doi:10.1001/jamainternmed.2013.9257.
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Importance  Health care costs in the United States are rising rapidly, and consensus exists that we are not achieving sufficient value for this investment. Historically, US physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health.

Objective  To quantify the Medicare payment gap between representative cognitive and procedural services, each requiring similar amounts of physician time.

Design  Observational analytical study comparing the hourly revenue generated by a physician performing cognitive services (Current Procedural Terminology [CPT] code 99214) and billing by time with that generated by physicians performing screening colonoscopy (Healthcare Common Procedure Coding System code G0121) or cataract extraction (CPT code 66984) for Medicare beneficiaries.

Setting  Outpatient medical practice.

Participants  Medical care providers of outpatient services.

Exposure  Work relative-value unit assigned to physician services.

Main Outcome and Measures  Payment for physician services.

Results  The revenue for physician time spent on 2 common procedures (colonoscopy and cataract extraction) was 368% and 486%, respectively, of the revenue for a similar amount of physician time spent on cognitive care.

Conclusions and Relevance  Our analysis indicates that Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care and illustrates the financial pressures that may contribute to the US health care system’s emphasis on procedural care. We demonstrate that 2 common specialty procedures can generate more revenue in 1 to 2 hours of total time than a primary care physician receives for an entire day’s work.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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