Physician Payments, Patient Out-of-Pocket Payments Up a Little in 2014

The Robert Wood Johnson Foundation and athenahealth (NASDAQ: ATHN) have released their analysis of physician payments in 2013 versus 2014. athenahealth is an extremely innovative provider of cloud-based electronic medical records (EMRs) to physicians, and has a very complete set of data on their clients payments from all payers.

The result? Not much change from 2013 to 2014, the first year of full-throttle Obamacare:

Primary payments—those made by insurance carriers—to office-based physicians rose moderately between 2013 and 2014. Payments declined for orthopedics and surgery while increasing for primary care and obstetrics-gynecology. Patients’ payment obligations rose for all specialties, and deductibles were the largest category of increased patient spending.

(K. Hempstead, et al., “Tracking Trends in Provider Reimbursements and Patient Obligations,” Health Affairs, vol. 3, no. 7, July 2015, pp. 1220-1224)

Despite rising deductibles, the actual change in direct patient responsibility for payment verged on trivial. For example, an established patient in a primary care practice paid $26.38 per visit (on average) in 2013 and $28.73 in 2014. The third-party payer paid $91.70 in 2013 and $94.84 in 2014. The total physician payment was $118.08 (2013) and $122.13 (2014).

What is disturbing are the terms assigned in the report to the two sources of payment: The third-party payment is labelled “primary payment” and the out-of-pocket payment is labelled “patient obligation.” Especially in general practice, it is the patient who should be identified as the primary payer.

Comments (2)

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  1. Barry Carol says:

    I think it’s reasonable to refer to the primary payer as the person or entity that pays most of the bill. That said, I don’t think patients should expect insurers to pay for routine care just as they don’t expect car insurance to pay for oil changes.