Physician losses from Medicare and Medicaid discounts: how real are they?
Cromwell, Jerry L
Date of Pub
Physicians' claims that extensive Medicare and Medicaid fee discounting imposes an inequitable burden on them are examined
using survey data from the Health Care Financing Administration on 5,000 primary care physicians. A definite fee hierarchy
is documented, with the physician's usual charge at the top and Medicare and Medicaid allowables at the bottom. Under usual,
customary, and reasonable methods, physicians can use fees to maximize payment, and insurer attempts to control fees result
in both sides participating in a revenue maximization-expenditure control game. Raising Medicare and Medicaid allowables to
the physician's usual fee is shown to result in large windfall gains that are unnecessary and unjustified in terms of work
effort, human capital investment, or eliciting an adequate supply of practitioners.
Fee Schedules : Fees, Medical : Rate Setting and Review : Blue Shield : Comparative Study : Income : Medicaid/economics :
Medicare/economics : Models, Theoretical : Specialties, Medical/economics : Support, U.S. Gov't, Non-P.H.S. : United States