Insurance Payments Increase for Primary Care, but Decrease for Some Specialties

Insurance payments increased for primary care and obstetrics-gynecology between 2013 and 2014, but they decreased for orthopedics and surgery. The payment obligations of patients, meanwhile, rose across all specialties. Researchers analyzed trends in provider reimbursement and patient obligations for 17 million visits and published their findings in the July issue of Health Affairs.

Primary care providers saw the highest increase in payments made by insurance carriers for both new (3.8%) and established (3.4%) patients, Medscape reported. According to researchers, the hike may be due to enhanced coverage for selected preventive services, many of which fall within primary care, mandated by the Patient Protection and Affordable Care Act. The increases may also reflect a strategy by insurance carriers to encourage the use of primary and preventive care over specialty care, researchers reasoned.

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Obstetricians-gynecologists received a 2.9% increase for established patients between 2013 and 2014, but payments for new patients decreased 0.1% over the same period. For orthopedics, insurance payments decreased 3.7% for new patients and 2.8% for established patients. For surgeons, payments dropped 1.3% for established patients and 0.8% for new patients, according to the Medscape report.

Overall, payments across the specialties rose modestly, researchers found, increasing an average of 2% for established patients and 1.4% for new patients. Patients’ payments increased across all specialties, too, with the mean patient obligation rising 3.5% for established patients and 2.7% for new patients, mostly due to an increase in deductibles.—Jolynn Tumolo

References

1. Frellick M. Payments up for PCPs, down for orthopedists, surgeons. Medscape. July 7, 2015.
2. Hempstead K, Sung I, Gray J, Richardson S. Tracking trends in provider reimbursements and patient obligations. Health Affairs. 2015;34:1220-1224.