Radiologists receive commercial insurance payments at 180% of Medicare pricing
Radiologists receive commercial insurance rates roughly 1.8 times higher than Medicare prices, according to a new analysis from the Urban Institute published Monday.
That placed radiology fourth on the list of 17 specialties examined by the Washington-based think tank, behind anesthesia (330%), emergency medicine (250%) and neurosurgery (220%). Dermatology was the only branch of medicine examined that fell below Medicare rates, at 90%.
The analysis arrives as lawmakers consider using the federal payment program as a guidepost to help control healthcare spending. Radiology and other specialties in the analysis would face the largest income losses, if forced to accept such reduced rates from private payers, the authors noted.
“Policy proposals that seek to use Medicare rates as a benchmark for commercial payments face considerable opposition,” Stacey McMorrow, PhD, principal research associate with the Urban Institute, and co-authors wrote Oct. 18. “Though a multiyear transition and plans for access-monitoring would likely be included in any proposal, concerns remain that such policies could be quite disruptive to physician practices and could threaten access to care.”
McMorrow et al. utilized information from data nonprofit FAIR Health, incorporating commercial claims from March 2019 through February 2020. The sample contained about 20 services per specialty representing roughly 40% of total professional spending. A brain MRI, for instance was priced at about 2.2 times more under commercial insurance than Medicare, the analysis found. Family medicine, OB-GYN, dermatology, ophthalmology and psychiatry had the lowest commercial markups compared to public payment, all hovering at around 110%.
The authors cautioned that their study may not be nationally representative, and they excluded out-of-network rates to providers, among other constraints.
“Despite these potential limitations, our findings suggest wide variation across physician specialties in potential payment rate reductions if commercial rates were set closer to current Medicare rates,” they concluded. “Whether such payment rate reductions would threaten patient access is unknown but will be important to consider as specific policies are developed or implemented.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.