Medicare Pays More For Services Performed In Hospitals Than In Doctor’s Offices

The Philadelphia Inquirer on July 12, 2015 reports that one consequence of hospitals’ buying up physician practices is that routine procedures are now being performed more often in the hospital than in the doctor’s office.   This is costing more as Medicare pays more if your colonoscopy or echocardiogram is done in the hospital.   The differences are significant.  The Medicare reimbursement rate for a colonoscopy in your doctor’s office is $625 versus $1383 in the hospital.  For an echocardiogram, it is $189 versus $453.   It has been reported that 14 million screening colonoscopies are done in the US each year.  By my calculation, if just 25%  of those formerly done in the office  are now done in the hospital instead of the office, that could represent an additional cost of about  2.5 billion dollars just for routine colonoscopies.  Other routine procedures investigated include ultrasound, MRI, bone-density and pulmonary tests.   The Medical Payment Advisory Commission, a federal agency that advises Congress, has recommended closing or reducing the gap, but Congress has taken no action to date.  It would be interesting to know if the big private health insurers also pay more for the same test when it is done in the hospital.

From the desk of Edward E. Houseman, attorney for Liever, Hyman & Potter, P.C., serving Eastern and Central Pennsylvania, including Berks, Schuylkill, Chester, Montgomery, Lebanon County and other areas in the practice of personal injury law.

Latest Posts