Are Surgeons Being Fairly Compensated by Medicaid?

[drusso]

Probably time for Pain Medicine specialty societies to start asking the same question. Comprehensive pain management is very resource intensive work.

Are Surgeons Being Paid Fairly By Medicaid? A National Comparison of Typical Payments for General Surgeons
Presented at the Southern Surgical Association 127th Annual Meeting, Hot Springs, VA, December 2015.

Charles D. Mabry
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Affiliations

• Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

• Arkansas Trauma Education and Research Foundation (ATERF), Little Rock, AR

Correspondence

• Correspondence address: Charles D. Mabry MD FACS, 1801 W. 40th Ste 7B, Pine Bluff, AR 71603.

, MD, FACS

x
Charles D. Mabry
Search for articles by this author
Affiliations

• Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

• Arkansas Trauma Education and Research Foundation (ATERF), Little Rock, AR

Correspondence

• Correspondence address: Charles D. Mabry MD FACS, 1801 W. 40th Ste 7B, Pine Bluff, AR 71603.

Lori A. Gurien

Affiliations

• Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

, MD, MPH

Samuel D. Smith

Affiliations

• Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

, MD, FACS,
Steven C. Mehl

Affiliations

• Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

Figures

Figure 1

Map of US with impact analysis. Medicaid discount or gap of 13 selected CPT codes by state, compared with Medicare payment.

Abstract
Background
Both the Medicare (MCR) and Medicaid (MCD) programs turn 50 this year. MCR has developed a national resource-based payment methodology for physicians’ services, with broad input by specialty societies, while MCD payments are set by individual states by various means.

Study Design
We have conducted the first national comparison of payment methodology of MCD versus MCR for procedures commonly delivered by general surgeons (GS). Using the most recent CMS Medicare data for frequency of allowed charges for GS, we selected the most frequently billed procedures and gathered data from the 50 states for MCD and MCR payments. We determined the “Medicaid discount” (MCD payment – MCR payment) expressed as dollars and percent, as well as dollars paid per relative value of work ($/RVW).

Results
We have discovered wide variations in MCD payment between states for the same procedures, demonstrating unexplained “discounts” of MCD payments in relationship to MCR. We found that MCD payments show wide variations across the states, with many states paying far less than MCR for common, essential procedures.

Conclusions
These findings call into question the fairness of MCD reimbursement for general surgery services in America. This discount to MCR could act as a disincentive for surgeons to care for some patients, based upon the state of residence. These unexplained discounts could have significant long term effects for patients dependent upon the MCD program. Our study should act as a stimulus for states to examine their payment methodologies in order to provide more uniform and fairer payment for surgical procedures.

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[Dr. Ice]

It depends on the structure of your group and where you practice. In my group, the ortho surgeons get paid very well for procedures from Medicaid. Apparently the group negotiated rates with caid because they are a large group and no other group in the immediate geopraphic area takes it. By default procedural intervention is decently reimbursed but office visits are not reimbursed well.